INNOSERV work package 2: Identification of theoretical criteria for
Transcript of INNOSERV work package 2: Identification of theoretical criteria for
INNOSERV
Work Package 2
Theoretical trends and criteria for
lsquoinnovative service practicesrsquo in social
services within the EU
August 2012
1
Authors
Chris Hawker (University of Southampton)
Jane Frankland (University of Southampton)
with input from
Olav Helge Angell (Diakonhjemmet)
Jamie Bolling (ENIL)
Elisabetta Bucolo (IAE Paris- Pantheacuteon Sorbonne University)
Chiara Crepaldi (IRS)
Hanne Marlene Dahl (Roskilde University)
Eugenia De Rosa (IRS)
Johannes Eurich (Heidelberg University)
Philippe Eynaud (IAE Paris- Pantheacuteon Sorbonne University)
Kristian Fahnoslashe (Roskilde University)
Gemma-Dorina Favaro (Hamburg University of Applied Sciences)
Simon Gunter ((Hamburg University)
Adrienn Kiss (Budapest Institute)
Gorgi Krlev (Centre for Social Investment Heidelberg University)
Elsa Laino (Solidar)
Andreas Langer (Hamburg University of Applied Sciences)
Georg Mildenberger (Centre for Social Investment Heidelberg University)
Sanja Nikolin (ENIL)
Flavia Pesce (IRS)
Agota Scharle (Budapest Institute)
Anika Strifler (Heidelberg University)
Dorottya Szikra (Budapest Institute)
Jean-Marie Vanhove (EASPD)
Luk Zelderloo (EASPD)
2
Contents
Summary 4
1 Background identifying and developing innovation trends and criteria 5
11 Framework developmenthelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip5
2 Innovation service development and social change paradigm development and
service development 6
3 Developing and defining innovation criteria 8
31 Innovation responses innovation in practicehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip10
32 Noveltyhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip13
33 Hallmarks of innovationhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip15
331 Contextual fit 15
332 Improvement in quality 15
333 Sustainability 16
4 Drivers of innovation key societal changeshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip17
41 Demographic change as a key societal change driving innovation in the
health and welfare social service sectors 18
42 Aspirations as a key societal change driving innovation for health and for
education service sectors 20
43 Lifestyles as a key societal challenge driving innovation in the health
service sector and also in the cross sector services of health and education 20
44 Technology as a key societal change driving innovation in the health
service sector 21
45 Continued inequalities as a key societal challenge driving innovation in
welfare and education service sectors also in cross sector services of education
and health and welfare and education 21
46 Independent living as a key societalchange driving innovation in the
welfare service sector 21
47 Social roles as a key societal change driving innovation for welfare and for
education service sectors 21
48 Organisational changes as a key societal change driving innovation in
welfare service sectors 22
49 Changing management styles as a key innovation challenge for the
education service sector and in cross sector services of the health and
education sector 22
5 Other key challenges driving innovationhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip23
6 Conclusions and next steps 24
7 Bibliography 25
3
8 Appendices 27
Appendix 1 Summary of types and criteria of innovation used in Work Package 3
to identify practiceshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip27
Appendix 2 levels of innovation identified within INNOSERV Work Package 2
literature reviewhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip29
Appendix 3 analysis of social challenges and changes driving innovationhelliphelliphellip33
4
Summary
This report identifies theoretical trends and criteria for innovative service
development practices in social services developed through the INNOSERV project
and based on
The Innoserv WP1 Report
A further review of the relevant literature
Inputs from consortium members particularly at a two day workshop held in
June 2012
The INNOSERV criteria framework is used to show key links between innovation
criteria and the pressures for change and development in social services to identify
future developmental trends and to link key aspects of innovation with current and
future challenges which are driving innovation and social change
Key issues relating to the trends are developed in the report These will be tested
through the selection of innovation case studies illustrating a range of practices
from across Europe to inform a Europe-wide consultation process with key
stakeholders to identify issues gaps demands and indications for further research
on innovation in social services in Europe
5
1 Background identifying and developing innovation trends and criteria
This report identifies theoretical trends and criteria for innovative service
development practices in social services developed by the INNOSERV project as part
of the second work package The trends and criteria have been formed into a
criteria framework to be used in later work packages to inform the choice of project
case studies The purpose of the INNOSERV work programme is to identify the
innovation phenomena potentials and processes important to future research
around innovation in social services
The report draws on the INNOSERV Work Package 1 literature review (Crepaldi et al
2012) which discusses concepts definitions criteria and the content of innovation
in social services plus the work undertaken to identify innovative social services in
Work Package 3 This report builds on that work in order to identify theoretical
trends and criteria for investigating and categorising innovative practices
11 Framework development
This framework and analysis have been developed through the following processes
1 The criteria development draws heavily on the work undertaken within the
INNOSERV Work Package 1 literature review which describes concepts
definitions criteria and content of innovation and on work for the process of
collection of innovative practices within Work Package 3 The latter work
which began in February 2012 developed initial types and criteria for
assessing innovation These are given in full in the report of that work
package and are shown in an abbreviated form in Appendix 1 of this report
2 Eleven partner organisations and a member of the advisory board took part
in a teleconference discussion concerning aspects of criteria development in
March 2012 This identified the key research questions for Work Package 2
as
a What changes in social political economic and technological
development are driving changes in social services (see point 22 in
WP2 description)
b What types of innovation developments are being used in responding
to these changes (see point 23 in WP2 description)
3 Further literature research was undertaken in order to identify specific issues
relating to current societal challenges which act as driving forces for social
service innovation and to place innovation in social services within a dynamic
theoretical context
4 The Consortium members took part in a scenario planning exercise to
assess societal challenges which are driving forces for innovation in social
services now and into the future The results of this exercise were discussed
at a Consortium meeting in June 2012
5 Work packages 3 and 4 were managed through a parallel process all of the
first four work packages influencing each other
6 Criteria for the analysis of innovation were agreed at the Consortium meeting
and the framework developed
7 The criteria were then used for the final selection of projects which is
reported in Work Package 4 (Eurich and Strifler 2012)
6
This report draws very much on the contribution of all the partners although
responsibility for writing it lies with the University of Southampton UK
The report begins with a brief review of the background theoretical concepts
relating to how innovation developments can be understood against knowledge and
practice development in social services It goes on to present the INNOSERV criteria
framework and to explore each of its components
2 Innovation service development and social change paradigm
development and service development
The assessment and understanding of innovation in social services takes place
within a number of organisational and cultural contexts
Our understanding of what is normal and what is new informed by
o Cultural assessments of what is safe and a reliance on lsquoconfirmedrsquo or
accepted knowledge
o The capacity to take risks and try out new ideas in practice or apply an
existing idea in a new situation creating new outcomes
The legal and political environments in which services are developed and
whether they promote adoption of new ideas and practices
In the area of social services these kinds of developments are embedded in a
number of sociologically derived factors including
Local social power structures
Economic capacity or constraint
Political ideologies
Professional ideologies and expertise
These variously integrate into a number of understood social lsquoparadigmsrsquo which
support or inhibit innovatory change Paradigms can support change by enabling
innovative developments to occur to improve the quality or functioning of social
systems within the prevailing paradigm These paradigms can also inhibit thinking
and action which might challenge the fundamental basis of the paradigm
A number of innovative developments can also accumulate in a system and which
collectively begin to challenge the basis for the paradigm itself These may support
the shift into a new social paradigm and inform influence and even radically alter
the way social systems work and develop
An example of this in practice is how the understanding and legal acceptance of
equality for people with disabilities particularly learning disabilities grew from a
number of innovative developments
lsquoNormalisationrsquo (Wolfensburger 1975) proposed that society should include
people with disabilities within the range of normal human existence
The de-institutionalisation of care which can for example be traced to
people with learning disabilities being supported to live in ordinary domestic
settings rather than specialist hospitals in British Columbia Canada
alongside other similar development in other settings
The lsquoindependent livingrsquo movement through which people with disabilities
argued that they should manage their social supports to meet their own
7
personal objectives rather than accept the standardised offerings of social
services organisations
The development of a lsquosocialrsquo rather than lsquomedicalrsquo model for how disability
should be described and understood
Each of these was an innovation some more challenging to the prevailing lsquocarersquo
paradigm than others During the last years of the 20th
century together they
accumulated to deliver a change in the fundamental paradigm informing most
European social systems so that what became an lsquoequalitiesrsquo based framework now
underlies the basis for these social systems (See for example Oliver 1990)
In practice of course these developments occurred simultaneously and in different
places The lsquoequalitiesrsquo arguments developed in the political domain at the same
time and informed and were informed by the practical innovations The
accumulation of the ideas to challenge legal frameworks and care systems occurred
in different ways in differing national contexts The pace of such changes taking
place in Eastern European countries now seeking to adopt these ideas in a single
often politically driven change illustrates an extreme form of lsquoinnovationrsquo adoption
This kind of development reflects processes of knowledge development identified
by Kuhn (1962) as lsquoscientific revolutionrsquo Kuhn noted that developments can occur
within what he calls lsquonormal sciencersquo until individual discoveries appear to challenge
the prevailing paradigm Some accommodations are often then made to the
paradigm but then once enough discoveries appear to challenge the basis of the
prevailing paradigm a new model has to be formed to accommodate the
discoveries lsquoNormalrsquo science can then resume within the new paradigm until this is
then in turn challenged The generation of a new paradigm also creates the
opportunity for new hypotheses which can be tested to form an expanded range of
ideas and knowledge These theories are complex and have developed a number of
critical channels for understanding how knowledge development is shaped or
limited For example some paradigm frameworks disable discovery by forcing a
rigid linguistically determined structure on knowledge development which disables
or actively prevents discovery (see for example Lakatos and Musgrave 1970)
This approach helps to understand how innovative developments in social services
relate to models of social change (see for example Sullivan 1987) Innovations can
occur within social systems but then accumulate to create or require a new social
model for social services The new social lsquomodelrsquo then generates a number of
innovations within the new framework so the equalities based social systems for
people with disabilities continue to generate for example new ideas in
employment for people with disabilities as a part of the lsquoindependent livingrsquo
concept
Innovation development therefore takes place in a dynamic environment Social
services innovations are informing social change and vice versa In order to identify
future innovation trends in social services it is important to understand how
changes in wider society will generate demands for and the development
space for innovation in social services
social services innovation will itself generate new opportunities for social
change
Using this kind of theoretical underpinning this report draws on the INNOSERV
innovation criteria developed in Work Package 1 and reviews the impact of key
societal changes to identify a set of relevant theoretical trends
8
3 Developing and defining innovation criteria
A review of the INNOSERV Work Packages 1 - 3 was undertaken at a meeting of
consortium members in June 2012 The INNOSERV Work Package 1 literature review
(Crepaldi et al 2012) identified a variety of definitions of innovation in services
service innovation and social innovation The literature review provided a first
working definition of innovation in social services shown in box 1 below and also
identified an extensive list of criteria for innovation which is included as appendix
2 This Work Package (2) contributes analysis of the key social challenges driving
innovation in social services Work Package 3 involved the collection of innovative
practice examples using some initial categorisation of innovation (see appendix 1)
BOX 1 INNOSERV first working definition of innovation in social services Innovation in social services can be defined as a type of social innovation process Innovation of social services is delivering services in another way as an answer to current and future challenges in society It mainly concerns (i) designing and implementing new social services to face new needs or unmet needs (ie types of services offered to face autism migrants with an irregular status violence against women) (ii) introducing new social services (or new mechanisms or practices) new interfaces with clients or new practices in social work in pre-existing social services Novelty improvements (effectiveness and efficiency) and sustainability are only first set of criteria to identify innovation in social services Values and the socio-cultural foundations of innovations in the social sphere should be considered Firstly in dealing with social services 1 respond lsquoto pressing social demands which are not addressed by the market and are directed to vulnerable groups in societyrsquo 2 address societal challenges at a level in which the boundary between social and economic blurs and societal challenges are directed towards society as a whole 3 generate systemic changes in changing attitudes and values strategies and policies organisational structures and processes delivery systems and services (Europe 2020 strategy Executive Summary EC) Social services innovations can be considered as ways to enhance processes and the outcome of social innovation Secondly situating social services within a social innovation framework means to focus on ways processes and mechanisms activated by social services that are able (a) to cope with more pressing social needs (b) to stimulate new solutions mobilizing peoples creativity and connecting people ideas and resources to a context of limited resources and rising costs (c) to be able to see social challenges also as opportunities (EC 2010 Murray Caulier-Grice Mulgan 2010) Crepaldi et al 2012 25-26
9
Following the review of these work packages the key elements of innovation for the
INNOSERV project were identified as
relevance to current and future societal challenges
type of innovation response
novelty
improvement
sustainability
context of innovation
These elements were incorporated into the INNOSERV criteria framework developed
to link these key innovation elements together The framework is shown in box 2
Box 2 The INNOSERV criteria framework linking aspects of innovation
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
10
The core of the framework focuses on the ways in which key innovations respond to
drivers and challenges It links distinct types of innovation criteria First there are
those criteria which together define innovation type of innovation or response
novelty and hallmarks of innovation including context improvement and
sustainability Linked to these are drivers or key societal challenges driving
change in social services and other challenges prompting innovation
The remaining sections of this report provide a rationale and explanation of each of
these five separate aspects that make up the framework along with definitions and
explanations of the individual elements within each to provide an analysis against
which the remaining developmental phases of the Innoserv programme can be
assessed
31 Innovation responses innovation in practice
The INNOSERV Work Package 1 literature review and collection of examples has
helped to explicate innovation operating at different lsquolevelsrsquo within service systems
The levels identified in the literature review are shown in summary form in Box 3
and are provided in full including examples in appendix 2
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
11
From this five types of response are detailed within the INNOSERV criteria
framework new service new form of delivery new form of governance new form of
resourcing and new way of evaluation The meaning of these five levels is provided
in table 1 and examples are given to illustrate this It should be noted that the
levels of response are not necessarily exclusive and a specific practice innovation
may fall into more than one category
Box 3 identified levels of innovation in social services
organizational level (ie organization of the provision of social services
type of service target group delivering logics)
regulatory and legislative level (lsquohow services are regulated organised
provided and financed the modalities of service provision the types of
relationships between external service providers and public authoritiesrsquo
EC 2006 p 8)
organizational level ndash connection and cooperation (partnership
networks governance)
professional level (social work methods and practices) -
users level
conceptual level and values
public policy level (policy framework programs and social policies)
financial and economic sustainability level (and scaling-diffusion-
transferability of innovation)
evaluative level and attention to quality (quality standards)
Crepaldi et al 2012 98-99
12
Table 1 Levels of response
Response Definition Example
New service New or improved
product of the scheme
or process
Personalised instead of
generic service
New form of delivery New or improved means
by which the outcome is
achieved
Self-help or social enterprise
instead of government agency
New form of
governance
New or improved way
the scheme or process is
managed and where it
draws authority from
Co-operative or user managed
instead of public service
New form of
resourcing
New or improved
financial human or
physical inputs to the
scheme or process
Grant-funded collectively
staffed organisation instead of
professionally managed
government agency
New way of
evaluation
New or improved
parameters by which
success is judged
User assessment of
effectiveness instead or
professional determined
criteria
It is important to note that innovation within a service is more challenging to define
and measure than innovation in the sense of a product (OECD 2005) while a
product is a tangible entity innovation within service provision can be a either a
product or a process and can occur at different levels of service provision and there
are a number of potential complexities which may inform the structure set out in
table 1
Phills et al (2008) for instance state that social innovation can be
ldquoa product production process or technology (much like innovation in
general) but it can also be a principle an idea a piece of legislation a social
movement an intervention or some combination of themrdquo (39)
In discussing public sector services Hartley (2005) emphasises that innovation is
ldquonot just a new idea but a new practicerdquo (27) and argues therefore that definitions
need to recognise practical impact For services this impact might be at one of
several levels
The organisation literature on innovation offers the initial distinction between
product and process innovation to which other types of innovation have been
added such as position and paradigm innovation (Tidd and Bessant 2009) For
social service oriented innovation further types are added
For example Hartley (2005) identifies the levels of product service process
position strategic governance and rhetorical innovations Hochgerner (2011) adds
social types of innovation to include roles relations norms and values
13
Osborne and Brown (2005) critique a number of typologies to classify innovation
from the management literature They point out that the dichotomy between
process and outcome makes them alternatives whereas an innovation and
particularly innovation in services can be both With services there is often not a
distinct separation between product and process with production delivery and
consumption of services often occurring simultaneously (OECD 2005)
32 Novelty
The next aspect is innovation is novelty In terms of novelty a three way
categorisation is proposed for INNOSERV new perspectives on old needs or
problems new practices for old needs or problems a new practice for a new need
The categorisation reflects the need for innovation to address both existing needs
and new needs Again there is much discussion in the literature about novelty in
relation to innovation Two points are addressed which can be summarised as
lsquowhat degreelevel of novelty equates to innovationrsquo and lsquonew to whomrsquo
The first distinction to be made is between different levels of innovation
ldquoThere are degrees of noveltyrunning from minor incremental
improvements right through to radical changes which transform the way we
think about and use them Sometimes these changes are common to a
particular sector or activity but sometimes they are so radical and far-
reaching that they change the basis of societyhelliprdquo (Tidd and Bessant 2009
27)
Tidd and Bessant usefully break down the incremental-radical continuum as lsquodoing
what we do betterrsquo lsquonew to the enterprisersquo and lsquonew to the worldrsquo (Tidd and
Bessant 2009 38)
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
14
While for some writers a change must be radical or pattern breaking in order to be
innovation it has been argued that within services innovation can be small
adjustments (Fuglsang 2010) Fuglsang in fact argues for a view of innovation in
public sector services as a process of building of skills and expanding routines (68)
The second part of the argument lsquonew to whomrsquo is whether innovation relates to
absolute first use A common to view of innovation is not just those elements
developed within an institution but also those adopted from others (for example
see OECD (2005) for business sector innovation Phills et al (2008) regarding social
innovation Hartley (2005) and Koch (2005) in relation to innovation in public
services) Phills et al (2008) for example state
ldquoAlthough innovations need not necessarily be original they must be new to
the user context or applicationrdquo (Phills et al 37)
Osborne and Brown (2005) purport that most studies consider newness as new to a
person organisation society or situation but not necessarily first use (2005 120)
The authors go on to argue that these are in fact different forms of innovation
differently termed as objective and subjective innovation (Kimberly 1981) or
intrinsic and extrinsic innovation (Downs and Mohr 1976)
Hartley (2005) expounds the dissemination and adaptation of innovation to other
contexts as particularly important for public sector services arguing that public
goals ldquocan be enhanced through collaborative arrangements to create share
transfer adapt and embed good practicerdquo (27) She terms this ldquorsquolateralrsquo innovationrdquo
(33) of good practice adoption and adaption
An example of this approach to defining innovation within social services is seen in
the UK Government policy document on innovation within the National Health
Service which states
ldquoinnovation is as much about applying an idea service or product in a new
context or in a new organisation as it is about creating something newrdquo
(Department of Health 2011 9)
15
33 Hallmarks of innovation
Within social service systems it is not sufficient to focus only on novelty as a
marker of innovation In addition the INNOSERV framework includes certain
hallmarks of innovation including assessment of context quality and sustainability
331 Contextual fit
Different innovative approaches need to fit within different service framework
contexts and need adaptation to those contexts Drawing further on the above
discussion of novelty INNOSERV employ this to mean new to a given (for example
national) context This will reflect the diversity of social service contexts within the
European Union Case studies will also consider transferability of an innovation
from one context to another
332 Improvement in quality
ldquoIn public servicesinnovation is justifiable only where it increases public
value in the quality efficiency or fitness for purpose of governance or
servicesrdquo (Hartley 2005 30)
It is commonly understood that innovation is about improvement as well as novelty
Hartley (2005) offers a model which sets out the possible relationships between
innovation and improvement These relationships are for organisations showing no
improvement and no innovation improvement but no innovation innovation but no
improvement innovation and improvement Important points to highlight from this
model relate to innovation but no improvement first that innovations may not
always lead to success and a level of failure is to be expected second that
innovation can lead to increased but undesired choice loss of performance due to
the process of learning and innovations that are ultimately of no value In terms of
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
16
what is to be measured as improvement Hartley maintains that beyond
improvements in service quality and fitness for purpose wider issues of public
value should be considered
The difficulties of measurement and evaluation of innovation in social services need
to be highlighted as the measures of success within a social project are difficult to
define (Bason 2010 Murray et al 2010) Improvement of social services can
include improved quality of life and access to economic and social opportunity
These issues may relate differently in the fields of health welfare and education
For instance quality of life within health may relate to physical health and mental
wellbeing at different stages of life within welfare issues such as equality of access
to housing cultural and community activities and employment are important
The INNOSERV case studies will include available information on the outcomes of
the innovative project although these will likely vary in terms of types of
measurement used by the projects
333 Sustainability
ldquoInnovation is not just about the originating idea but also the whole process
of the successful development implementation and spread of that idea into
widespread userdquo (Department of Health 2011)
It is recognised that change through innovation needs to be sustainable (Bereiter
2002) Achieving a sustainable innovation may involve streamlining of ideas and
altering them to work in everyday practice (Murray et al 2010 12) The
Normalisation Process Model offered by May and colleagues (May et al 2007 May
et al 2009) provides a theoretical explanation within the context of health care of
the processes through which interventions become embedded in practice and then
integrated and sustained
17
4 Drivers of innovation key societal changes
Innovation within social services needs to be relevant to key social challenges and
changes This relates to the purpose of social services in responding to pressing
social demands and societal needs It is therefore important for the INNOSERV
project to have an understanding of the key social challenges and changes driving
innovation to inform the lsquotheoretical trendsrsquo influencing future innovation
requirements As part of this work package we have therefore sought to identify
social challenges and changes which may act as driving forces of innovation and
shape the development of social service lsquoparadigmsrsquo and hence future social
change
Using a lsquoscenario planningrsquo methodology borrowed from management science can
help to test the limits to any paradigm and identify where new paradigm models
may be needed in the future This in turn should help to identify where future
research interests could be located to explore not just opportunities for innovation
within the current paradigm but also where socially driven change is creating new
opportunities (or indeed requirements) for social and social services innovation
Further these challenges feed into social service provision in terms of an imperative
to address new needs and level of need and issues of rising costs
The INNOSERV project undertook such a scenario planning process the outcomes
of which inform what follows here Using an extended literature study on future
social challenges in the European context a number of key factors promoting a
response from and requiring change in social services were identified Individual
partners made further analysis of the important social challenges within their own
national context The factors were synthesised into a table of key social challenges
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
18
(see appendix 3) separately for health welfare and education sectors although
there was much overlap in the challenges relating to each sector
Small groups involving two country based teams in each case took each social
challenge and considered how it may change and develop given current
understandings of the forces affecting change (some forces may promote change
and some may block change) These were considered against potential political
developments economic developments socialsociological change technological
development legallegislative changes and environmental factors with a focus on
volume nature depth timeframe and scale of importance in influencing future
developments in social services
This work informed extensive discussion at the INNOSERV June 2012 Consortium
meeting with regard to the impact of key future developments on innovation and
the choice of projects which should be used to test key innovation developments
and their relevance to future service development
Relevance is represented in the INNOSERV criteria framework by the lsquodriversrsquo box
which includes a number of examples The most significant social challenges and
changes which were identified by the Consortium as most pertinent to innovation in
social services are listed in table 2 (page 19) and are explored further in the
remainder of this section The selection of projects as case studies has included
analysis of which of these social challenges and changes are being addressed (see
Work Package 4 report Eurich and Strifler 2012)
41 Demographic change as a key societal change driving innovation in the
health and welfare social service sectors
Demographic change was identified as a driving force of innovation in both health
and welfare services in Europe Current demographic change is resulting in
increased numbers of people living longer into old age with a particular increase in
the numbers of people aged over 80 This is alongside a reduction in the numbers
of people of working age in part due to a declining birth rate Further socio-cultural
change is leading to concerns about levels of informal care for older people
While many people will want to live active lives in old age some will live with long
periods of ill health and will have complex care needs resulting from multiple co-
morbidities Most however prefer to live as independently as possible
Questions arise about the ability to meet these increasing care demands from
declining tax income bases In addition the specific needs of elderly patients with
dementia represent a unique challenge for nursing staff and the organisation of
nursing services Financing of the rising health care costs for public agencies or for
health insurance schemes requires sustainable solutions and structural reforms
Traditional models of hospital lsquoacutersquo care may not necessarily be appropriate for
meeting these health care needs
This all highlights the need to find alternative solutions to care needs including the
use of technology and reliance on informal carers Current responses which are
relevant to this driver include integration of health and social care services to
increase cost efficiencies use of technological solutions to enhance self care and
care at home and new paradigms such as Active Ageing
19
Table 2 Key social challenges and changes driving innovation
Social
challengesocial
change driving
innovation
Meaning Social service sector
in which driver is key
Demographic
change
Increase in numbers of over 65s Greatest
increase in over 80 age group Increase in
old age dependency ratio
Health sector
Welfare sector
Aspirations Rising expectations of citizens for better
quality of lifebetter care
Health sector
Education sector
Cross sector services of
education and health
Lifestyles Increase in certain diseases related to
obesity alcohol and drug consumption
and stress diabetes liver disease anxiety
and depression
Health sector
Cross sector services of
education and health
Technology Access to information new media
technology
Health sector
Continued
inequalities
Continued economic inequality
unemployment continued poverty
including child poverty continued
institutionalisation continued inequality for
people with disabilities ethnic minorities
gender inequalities impact of socio-
economic status on health outcomes
Welfare sector
Education sector
Cross sector services of
education and health
and welfare and
education
Independent living The approach now adopted by disabled
people to live as ordinary members of
society and in their chosen domestic
setting
Welfare sector
Social roles Changing families increase in single
households increase in single parent
families changing generational relations
(due to longer life expectancy) reduction in
extended families
Changing gender roles rising female
employment rates
Welfare sector
Education sector
Organisational
changes
Creating new organisational forms
application of more responsive
management processes performance
management culture
Welfare sector
Changing
management
styles
Application of more responsive
management processes
Education sector
Cross sector services of
education and health
20
42 Aspirations as a key societal change driving innovation for health and
for education service sectors
Citizen aspirations were identified as a key societal change acting as a driving force
for innovation within both the health and education sectors and across the
boundary of these sectors Across Europe citizens are expecting a better quality of
life including improved outcomes from health and care services and reduced
inequalities
In terms of the health service sector this both derives from and manifests itself in
a population which is more informed about health issues Consequently patients
wish to be more involved in decisions about their health and their health care
options and are more willing and able to participate in the management of their
condition There is less deference to the medical profession and greater willingness
to make demands on health services There are a growing number of patient led
movements which are challenging some medical traditions
This aspect is fundamental both to everyday practice and to the future development
trajectory for health care services While most health aspirations are limited by
current knowledge and medical skill as research and medical advance offer new
choices and opportunities but at greater costs there will be difficult questions for
political debate This could well result in very different more personalised and
lsquopatient managedrsquo models of health care support
In terms of the education service sector individualism and the connected
aspiration of lsquobeing involvedrsquo has been an increasing trend over the past years and
is expected to keep gaining importance This is not only reflected by agendas of
individually shaped curricula or learning arrangements in school but also by the
opening of the public (ie government funded) school system towards involvement
of the community (seniors in school corporate sponsoring external initiatives of
informal learning and personality formation etc) This is reflected in a similar way
in higher education (eg service learning) and adult education (lsquolearning regionsrsquo)
Across the boundary of health and education aspirations coupled with medical
advance lead to a desire for independence of disabled people and those with long
term conditions This highlights the need for health programs focussed on self
esteem
43 Lifestyles as a key societal challenge driving innovation in the health
service sector and also in the cross sector services of health and education
A key social challenge acting as a driving force for innovation for the health sector
and in the cross sector services of education and health is a recognised growth in
lsquolifestylersquo related conditions arising from unhealthy behaviours such as poor diet
alcohol consumption and smoking (although there is limited evidence of a decline
in smoking rates as its harmful effects are less well tolerated) Political investment
in public health is recognised as an important strategic ambition but often not
matched by financial resources Questions about personal responsibility are also
being asked with suggestions that people with poor health behaviours should not
be given the same priority to responsive health care services As other factors
impacting on health outcomes become more responsive to medical advance these
factors are growing in importance in their impact both on wider society and in
improving overall health outcomes
21
44 Technology as a key societal change driving innovation in the health
service sector
The growth in internet and web based technology is leading to an exponential
growth in access to information and new forms of communication More people
now use the internet as their primary health care information resource Web
lsquocommunitiesrsquo are linking and thus empowering people faced with similar health
challenges Telehealthcare solutions to on-going care needs are becoming more
widely available and are changing the patterns of demands for some health care
services Other new technologies for example in transport and in home assistance
devices are enabling greater independence for disabled people
As future generations use and expect more from access to information and
communication services health care services will have to respond to both the
demands and the opportunities created by such technology Technology can be
seen as both a driving force for innovation and as an enabler of change
45 Continued inequalities as a key societal challenge driving innovation in
welfare and education service sectors also in cross sector services of
education and health and welfare and education
Continued inequalities were identified as a key driving force for innovation within
both welfare and education sectors and in services which straddle the boundary
between education and health services and education and welfare services
Inequalities stem from issues of migration social originbackground
unemployment disability and gender and have been a source of the social
upheaval which has been seen in Europe in recent months
Within health education the link between socio-economic status and health is clear
with people from lower socio-economic groups experiencing poorer health and less
likely engaging in health promoting behaviours In the case of migrants health
messages need to be delivered in a culturally appropriate manner
46 Independent living as a key societal change driving innovation in the
welfare service sector
In terms of disability the emergence and spread of the independent living
philosophy has been a key change driving innovation in the welfare service sector
Typically innovation in this field involves new stakeholder roles with a much more
proactive role for service users in all stages of service provision design
implementation monitoring and fine tuning of services as well as a role in
coordination of different entitlementsservices andor administration and reporting
requirements The boundaries are being pushed further deeper and wider every
day Starting from persons with physical disabilities services are now promoting
active involvement of persons with severe mental disabilities a development that
was deemed impossible only 30 years ago
47 Social roles as a key societal change driving innovation for welfare and
for education service sectors
Changing social roles were identified as a key challenge driving innovation within
the welfare and education sectors These changes are within families and of the
family itself and include changing gender roles and changing family structures (eg
increase in single parent families increase in the numbers of older people living
alone) Families seem to be becoming a sphere of public or community interest
rather than an exclusively private one
Proper lsquosocializationrsquo of children is the key to building viable and sustainable
futures for individuals Early stage family intervention is necessary to prevent the
22
very emergence of conflicts lsquoExternalrsquo interventions often do not reach every day
interaction and thus the root causes of problems This is of significance for family
based projects as well as for care institutions and education providers
48 Organisational changes as a key societal change driving innovation in
welfare service sectors
The shifting of provision of services from the public sector into other sectors such
as independent profit making companies and social enterprises creates new
opportunities for innovation In addition there is an increasing move to provide
services locally in order to be more relevant and responsive and a move to
community based models of care
49 Changing management styles as a key innovation challenge for the
education service sector and in cross sector services of the health and
education sector
Connected to individualism as well as new social roles of individuals family
community and institutions management styles shaped by multi-stakeholder
involvement are gaining importance Community based models do not only increase
the complexity of players involved in the lsquovalue creationrsquo process but also the
enhancement of skill development and personality formation as well as the
fertilization of the educational landscape by innovative ideas expertise and
practices of diverse partners The latter fact also stimulates an increase in cross-
sectoral services (education health and social services) Simultaneously this
situation increases the necessity to spot choose and foster the lsquoinfluencesrsquo and
lsquocombinationsrsquo which realize the highest value through the assessment of social
impact
Increased emphasis is also being placed on illustrating and monitoring
performance Impact measurement and associated tools and practices gain
overarching importance
In terms of changing management styles within the health and education sector an
important aspect is the cooperation of different stakeholders and the involvement
of the community or userrsquos perspective Linked to increased user aspirations
people would like to take part in the development of programs and services With
their special knowledge of their condition for example they can contribute their
expertise within social services
23
5 Other key challenges driving innovation
Sociatal challenges and changes are of course only one driving force of innovation
In addition to these there are other meso and micro level factors which also drive
innovation These include research and development leading to new knowledge
professionally led innovation in response to users needs increasing costs of service
provision and demands for greater efficiency per se and specific political contexts
These other forces are included in the INNOSERV criteria framework in the
lsquochallengesrsquo box These factors are not a key focus for selection of projects for
INNOSERV as they are often very situation specific but will be noted in the case
studies where relevant The factors which prompt or trigger specific innovations
whether socially based or otherwise are not are not mutually exclusive (Bason
2010) and in there is a complex and interacting relationship between a variety of
factors for any given innovation lsquoinstancersquo In addition there are well documented
factors which act to inhibit the development of innovative responses (see Crepaldi
et al 201215)
This work package has sought to identify generic criteria and drivers but it must be
recognised that the dynamics of individual settings and local factors will impact on
the actual processes of adoption
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
24
6 Conclusions and next steps
This report has presented the framework which has been used within the INNOSERV
project to support the choice of innovative case studies and to assist in identifying
the innovation phenomena potential and processes important to future research in
this area The framework has been used to select projects as case studies (see Work
Package 4 report Eurich and Strifler 2012) The framework interlinks aspects of
innovation (novelty type context improvement sustainability) with analysis of
challenges and changes which are acting as driving forces of innovation in social
services As the project is future facing it is proposed that key social challenges
and changes are likely to inform the development of new change paradigms for the
delivery of social services across Europe The framework will inform further
development and testing of concepts through the next stages of the INNOSERVE
programme This process will result in descriptions for the key areas in which future
research on innovation in social services should be taken forward
25
7 Bibliography
Bason C (2010) Leading public sector innovation Co-creating for a better society
Bristol The Policy Press
Bereiter C (2002) Design research for sustained innovation Cognitive Studies
Bulletin of the Japanese Cognitive Society 9 321-327
Christensen CM and Overdorf M (2000) Meeting the Challenge of Disruptive
Change Harvard Business Review March-April
Clark M and Goodwin N (2010) Sustaining innovation in telehealth and telecare
WSDNA briefing paper London The Kings Fund
Crepaldi C De Rosa E And Pesce F (2012) Literature review on innovation in
social services in Europe (sectors of Health Education and Welfare
Services)INNOSERV Work Package 1 report
Department of Health (2011) Innovation Health and Wealth Accelerating Adoption
and Diffusion in the NHS London Department of Health
Eurich J and Strifler A (2012) European compared selection of innovative social
services INNOSERV Work Package 4 report
Fuglsang L (2010) Bricolage and invisible innovation in public service innovation
Journal of Innovation Economics 5 67-87
Greenhalgh T Robert G Macfarlane F Bate P Kyriakidou O (2004) Diffusion of
innovations in service organizations systematic review and recommendations
Milbank Quarterly 82581-629
Hartley J (2005) Innovation in Governance and Public Services Past and Present
Public Money and Management 25127-34
Koch P and Hauknes J (2005) On innovation in the Public Sector Publin report no
D20
Kuhn T (1962) The Structure of Scientific Revolutions Chicago The University of
Chicago Press
Lakatos I and Musgrave A (eds) (1970) Criticism and the growth of knowledge
London Cambridge University Press
May
C Finch T Mair F et al ( 2007) Understanding the implementation of
complex interventions in health care the normalization process model BMC Health
Services Research 2007 7148 doi1011861472-6963-7-148
May et al (2009) Implementing Embedding and Integrating Practices An Outline of
Normalization Process Theory Sociology 43 535-554
Murray R Caulier-Grice J and Mulgan G (2010) The Open Book of Social
Innovation London The Young Foundation
26
OECD (2005) Oslo manual Guidelines for collecting and interpreting innovation
data 3rd
edition
Oliver M (1990) The politics of disablement Basingstoke Macmillan Education Ltd
Osborne S (1998) Naming the Beast Defining and Classifying Service Innovations
in Social Policy Human Relations 51 9 1133-1154
Osborne S and Brown K (2005) Managing Change and Innovation in Public Service
Organizations London Routledge
Phills JA Deiglmeier K and Miller DT (2008) Rediscovering Social Innovation
Stamford Innovation Review 6 4 34-43
Sullivan M (1987) Sociology and Social Welfare London Allen and Unwin
Tidd J and Bessant J (2009) Managing Innovation Integrating Technological
Market and organizational Change 4th
edition Chichester John Wiley and Sons
UK Government Department of Health (2011) Innovation Health and Wealth
Accelerating adoption and diffusion in the NHS London Department of Health
Wolfensburger W (1975) The principle of normalisation in human services Toronto
National Institute on Mental Retardation
27
8 Appendices
Appendix 1 Summary of types and criteria of innovation used in Work Package
3 to identify practices
Identification of social service
Field(s) of service
Logic(s) of service
Self help or mutual aid logic Social care logic Multi-stakeholders logic Social
movements logic Combination
Activities of services delivered
Assistance for persons faced with personal challenges or crises (debt unemployment
drug addiction other) (Re)integration of persons into society (rehabilitation language
training for immigrants other) Services to the labour market (occupational training)
Social housing for disadvantaged groups Care (for the elderly children families )
Treatment and support of people with physical illnesses Treatment and support of
people with mental health problems Combination
Status of the provider organization
Public organization (governmental) Private organization ndash nonnot for profit Private
organization ndash profit Volunteer association Cooperative company or mutual company
Familyneighbourhood Civil society network Combination Other
Target group
Children Youngsters Elder people Unemployed people Poor people Immigrants
Disabled people People with chronic diseases ndash long-term health problems People with
acute or short term health problems No specific target group (eg territory-based social
services provision aiming at strengthen social ties) Combination Other
Size of the organization
Innovation
Type of innovation
New forms of organization resources hybridization new targeted actions new services
non-structural practices other
Innovative character
do the service practices appear to be something new in the field of social services
Origins of innovation
Supply side demand side broader operating factors
Impact on service performance
Effectiveness of service delivery
from user perspective cost effectivenesscapacity building sustainability of
innovation
Quality of provision
28
Socialization quality of life as judged by users and beneficiaries more inclusion
lower risk on exclusion participation of the user transition from institutional to
community based care
Potential wider effects
Promoting social and health equality sustainability new skills and jobs
increased social rights affordability of adequate and high quality health and long-
term care promotion of equality and non-discrimination equal access to adequate
provision
Transferability of innovations between national contexts
29
Appendix 2 levels of innovation identified within INNOSERV Work Package 2
literature review
Organizational level (policy organizational sectors)
New social services designed to face new needs or unmet needs
Search for new solutions to old needs new mechanisms or practices introduced in
preexisting
social services
to improve access to social services (ie more information increased
professionalism in
social work sector)
to guarantee entitlements (rights) for specific groups or minorities
to satisfy the demand for social services in a more complete and broad way
(holistic
approach)
to guarantee more participation and inclusion of citizens
New and increased Cross-Sectoral social services
Cross-Sectoral social services (ie teaching art to children while helping their mothers
for
job seeking and offering jobs for young artists)
Integrated care practices
Tearing down walls between sectors and the role of informal care
Sharing of knowledge
Better integration of Health and Social sector services
Territory based social services that contribute to the creation of training and job
opportunities for disadvantaged people
Solidarity-based social services
Social mediation for impaired and weakened people
Easy access to housing for poor families
New interfaces with clients
Logic(s) of service Self help or mutual aid logic Social care logic Multi-stakeholders
logic
Social movements logic
The development of the self-help sector
Actors New organizations (Cooperative society for social service provision ndashSCOP
Cooperative society as social enterprise with userrsquos involvement ndashSCIC)
New legal forms within structured public frameworks (Italy social cooperatives)
New provider organizations and existing organisations refashioned by new dynamics
New roles and relations among actors
New private organizations for profit and non-profit
Management style in the organization
Regulatory and legislative level
New architecture of the provision system
Socially responsible public contracts and social clauses (outsourcing)
Adherence to EU standards in transitional economies
Impact on institutional framework that shape innovation in social services
New arrangement between one or more government agencies andor external
organization
Organizational level ndash Connection and Cooperation (governance and partnership)
New networks and social movements established in order to design deliver and
finance
social services
Cooperation between sectors actors and different forms of provision
Cooperation between local actors
Increasing communication responsiveness
30
Utilizing connectivity and interdependencies
Modification of organizational systems (models of governance work organisation
number
of involved stakeholders in governance)
Public sector and local authorities as promoters of innovation and promoters of
crosssectoral
policy strategies
Third sector and user as promoters of innovation
Volunteer workers and initiatives launched by a group of citizens
Third sector and userrsquos engagement design (co-design and re-design services)
Joint decision process
Decision-making power not based on capital ownership
Employee and user driven innovation
Partnerships with users family carers and user organizations
Partnership between service users practitioners and academics
Community-based and participative health network in a local territory
Collaboration between public and volunteer organisations (NGOs) or between civil and
local
networks in collaboration with public organisations and social enterprises
New techniques for partnership building and functioning
Impact on social and power relations
Professional level (practitioners)
New practices in social work
Innovative tools (ie Theatre of the Oppressed) and the use of participated methods in
social
work (ie self-help group)
Networking
Individualised supports
New professional skills in social work
The use of informatics and new technologies in social work
Users
Participation and involvement of final users of services in designing delivering and
evaluating social services
Involvement of final users in promoting equality effectiveness and control and
adherence
to the needs of users
Conceptual Level (and value)
New models of society - Social goals participation user involvement community
benefit
New paradigms underlying a new social service concept or service delivery model (ie
new
inclusion paradigm active ageing)
Relationships and trust
Pursuing diversity
Better adjustment to usersrsquo needs more person centred support
More social services provision in less developed regions
New concept of accessibility of the service (ie for Roma families)
The concept of lsquoprogressive universalismrsquo
The Social Care Model
De-institutionalization and community care Improved home-based and community
services
Gender and diversity perspectives
Anti-discrimination and equality process
Increase of the level of recognition of social values objectives paradigms and goals
New models of interaction leading to social innovation processes
31
Public policy level (policy framework programs and social policies)
The new role of the system governance played by central (or local depending on
national
arrangements) government
Impact on public policies new public policy programme measure or intervention
Joint construction of a space for public action and redefinition of public governance
bodies
and methods
Innovative logics for public policies
Innovating the public sector
The new wide attention on anti stigma policies
E-government
Financial and economic sustainability level (and scaling-diffusion-transferability
of innovation)
New ways to overcome budgetary constraints
New approaches to acquire funding
The involvement of private investors
The introduction of special funds
The purchase of innovative practices by final users
Hybridization of resources (market redistribution and reciprocity resources)
New investment sources
Mobilising community resources taking full advantage of all endogenous resources
Improvement in efficiency and effectiveness
Financial and systemic sustainability Impact on the economy
Economic Environmental and Social Sustainability of Territory based social services
Financial tools necessary to territorial social initiatives and the way to unlock them
Capacity of spreading and diffusion
Evaluative level and attention for quality
Affordability availability and accessibility
New standards expected
New feedback loops from users and specialists
Social services of excellence as for quality efficiency and efficacy
New methods and creative tool-kits to strengthen and renew the quality of social care
services
Low-cost (for user) and high level quality of social services
Quality assurance moderation and accreditation mechanisms
New tools for monitoring social services - hearing all voices (users organizations
practioners staff family and friends)
Action research
Alternative economic and social indicators
Social impact and contribution of innovation in social services to social innovation and
social change ndash Assessment of innovation
Learning approach to evaluation ndash lsquoto learn from failuresrsquo
Developmental evaluation
Specifics for the Health sector
Disability from rehabilitation to integration and then to inclusion
Mental Health from segregation to inclusion and community care
HIV from segregationstigmatization to awareness campaigns for promoting self
protection
Innovation in the area of prevention of treatment and in the introduction of new
technologies
Emphasis on an inter-sectoral controlled and steered care in managed care models
replacement of the traditional insurance model
Integrated services
Technological progress
32
Specifics for the Education sector
Inclusive education
Inclusive education and training in collaboration with the civil society
Multicultural education
Integration of disciplines
Alternative schools non-regular schools and informal education
Link between formal and informal education
Community development based approaches
Connection between regular school and the system of social services
Experiential learning
Human rights education
Working lsquothrough relationshipsrsquo with children and young people
Problem based learning methodology
The lsquomedia educationrsquo The use of comics
ICT in schools
E-inclusion
Networks of schools
Improve supplement reinvent and transform learning
Sustained educational improvement
Learning Beyond the Classroom
Spreading a culture that values learning
More personalized approaches to learning
Using the web
Learning with and by not to and from
33
Appendix 3 analysis of social challenges and changes driving innovation
Welfare
Societal
change as
driving force
of innovation
in social
services
Meaning
description
Related
outcomesother
factors
Examples of innovative
responses
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
Empowerment self-
determination choice
The lsquoassertive userrsquo
Demand for more
individualised services of
better quality
Alternativecomplementary
providers
Personalisation
Co-production (new
userprofessional
relationships)
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demand on services
Potential for poor access
to services (from
communication
problems social
isolation)
Multiculturalism
Integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Declining female
caregiving
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
34
Increased demand for
services demand for
formal care
Continued
inequality
Continued
economic
inequality
unemployment
continued poverty
including child
poverty continued
institutionalisation
continued
inequality for
people with
disabilities ethnic
minorities gender
inequalities
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients
with complex
comorbidities increase
in certain diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing demand for
services Increasing
costsneed to make
limited resources go
further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
Decisions about value
marketization
Technological
development
Access to
information new
media technology
Facilitates self
determination increases
expectations and choice
population better
informed about
conditionsservicesright
s and less deferential
Users better able to
35
mobilise
Increased exclusion of
some groups with limited
access
New models of remote
care provision
Ability to exchange
information on quality
and experience
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Increasing costs
Decisions about value
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Organisational
change changing
management
styles
philosophies
Creating new
organisational
forms application
of more responsive
management
processes
performance
management
culture
Integration of
organisationsfunctions
new approaches to
lsquocommissioningrsquo of
organisationsservices
distortions caused by
lsquolocked inrsquo expenditures
(tertiary health care
residential care)
Decentralisation
deinstitutionalisation
marketization liberalisation
The lsquoenabling
statersquo Political
will fiscal space
Impact of financial
crisis competing
priorities for public
funds
Legacy of category-based
(not needs based) social
protection structural
transition
deindustrialisation
Health
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
EmpowermentSelf-
determination choice
Demand for more
individualised services of
better quality
Users better able to mobilise
Assertive lsquouserrsquo
knowledgeable patient
Alternativecomplimentary
providers
36
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demands on
services
Potential for poor access
to services (from
communication
problems social
isolation)
MulticulturalismTrained
health professionals
move to richer countries
integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Declining female
caregiving
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
Increased demand for
formal care services
Continued
inequalities
Unequal
distribution of
health risks and
health
outcomediseases
by socioeconomic
indicators
Unequal access to
care by social
status geography
gender and
ethnicity
Demographic Increase in
numbers of over
Increase in patients with
complex comorbidities
Increasing demand for care
Decisions about value Active
37
change 65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing costsneed to
make limited resources
go further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
ageing paradigm
Technological
development
Access to
information new
media technology
Self determination
expectations choice
population better
informed about
conditionsservicesright
s and less deferential
Ability to exchange
information on quality
and experience
New models of care provision
(eg telehealth care) new
health management systems
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Changing
management
stylesphilosophi
es
Application of
more responsive
management
processes
Decentralisation
deinstitutionalisation
marketization liberalisation
Lifestyle changes Increase in certain
diseases related to
obesity alcohol
and drug
Increasing
costsdemands for care
38
consumption and
stress diabetes
liver disease
anxiety and
depression
Education
Aspirations Rising expectations
by citizens for
better quality of
life
Self determination
choice consumerism
Education outside of formal
setting
Assertive user
Lifelong learningeducation
Migration Historical (post
colonial) migration
pan-EU migration
refugees
New needs for education
eg language and culture
Inequalities social
fragmentation
Social Roles Changing family
structure increase
in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
changing gender
roles rising
female
employment rates
Need to reconcile work
and family life
Parentingfamily skills
for vulnerable
parentsfamilies
Socialization of children
ndash social and emotional
deficits for children in
some environments
Work with families and
communities
Continued
inequalities
Inequality in
educational
accessattainment
by socioeconomic
status gender
people with
disabilities ethnic
minorities
Culture of failure
Promise to deliver social
mobility and economic
improvement
(Leadbeater and Wond
2010 pp 5-20)
Inclusive and multicultural
education
Differential support for
children from
lsquodisadvantagedrsquo
backgrounds
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients with
complex comorbidities
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
New group of older
39
learners
Technological
advance
Access to
information new
media technology
making learning
available in new
ways
Self determination
expectations choice
lsquoAssertive userrsquo
Increased exclusion of
some groups with limited
access
Changing
management
styles
philosophies
Community based models
Globalization Need to provide
educationtraining
which is suited to
modern knowledge
based global
economies
This report for the InnoServ project (grant agreement nr 290542) is supported
under the Socio-economic and Humanities Programme of FP7
Chris Hawker
Faculty of Health Sciences University of Southampton Building 67 University Road Highfield Campus Southampton SO17 1BJ
Tel +44 (0)23 8059 7968
Email CHawkersotonacuk
1
Authors
Chris Hawker (University of Southampton)
Jane Frankland (University of Southampton)
with input from
Olav Helge Angell (Diakonhjemmet)
Jamie Bolling (ENIL)
Elisabetta Bucolo (IAE Paris- Pantheacuteon Sorbonne University)
Chiara Crepaldi (IRS)
Hanne Marlene Dahl (Roskilde University)
Eugenia De Rosa (IRS)
Johannes Eurich (Heidelberg University)
Philippe Eynaud (IAE Paris- Pantheacuteon Sorbonne University)
Kristian Fahnoslashe (Roskilde University)
Gemma-Dorina Favaro (Hamburg University of Applied Sciences)
Simon Gunter ((Hamburg University)
Adrienn Kiss (Budapest Institute)
Gorgi Krlev (Centre for Social Investment Heidelberg University)
Elsa Laino (Solidar)
Andreas Langer (Hamburg University of Applied Sciences)
Georg Mildenberger (Centre for Social Investment Heidelberg University)
Sanja Nikolin (ENIL)
Flavia Pesce (IRS)
Agota Scharle (Budapest Institute)
Anika Strifler (Heidelberg University)
Dorottya Szikra (Budapest Institute)
Jean-Marie Vanhove (EASPD)
Luk Zelderloo (EASPD)
2
Contents
Summary 4
1 Background identifying and developing innovation trends and criteria 5
11 Framework developmenthelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip5
2 Innovation service development and social change paradigm development and
service development 6
3 Developing and defining innovation criteria 8
31 Innovation responses innovation in practicehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip10
32 Noveltyhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip13
33 Hallmarks of innovationhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip15
331 Contextual fit 15
332 Improvement in quality 15
333 Sustainability 16
4 Drivers of innovation key societal changeshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip17
41 Demographic change as a key societal change driving innovation in the
health and welfare social service sectors 18
42 Aspirations as a key societal change driving innovation for health and for
education service sectors 20
43 Lifestyles as a key societal challenge driving innovation in the health
service sector and also in the cross sector services of health and education 20
44 Technology as a key societal change driving innovation in the health
service sector 21
45 Continued inequalities as a key societal challenge driving innovation in
welfare and education service sectors also in cross sector services of education
and health and welfare and education 21
46 Independent living as a key societalchange driving innovation in the
welfare service sector 21
47 Social roles as a key societal change driving innovation for welfare and for
education service sectors 21
48 Organisational changes as a key societal change driving innovation in
welfare service sectors 22
49 Changing management styles as a key innovation challenge for the
education service sector and in cross sector services of the health and
education sector 22
5 Other key challenges driving innovationhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip23
6 Conclusions and next steps 24
7 Bibliography 25
3
8 Appendices 27
Appendix 1 Summary of types and criteria of innovation used in Work Package 3
to identify practiceshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip27
Appendix 2 levels of innovation identified within INNOSERV Work Package 2
literature reviewhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip29
Appendix 3 analysis of social challenges and changes driving innovationhelliphelliphellip33
4
Summary
This report identifies theoretical trends and criteria for innovative service
development practices in social services developed through the INNOSERV project
and based on
The Innoserv WP1 Report
A further review of the relevant literature
Inputs from consortium members particularly at a two day workshop held in
June 2012
The INNOSERV criteria framework is used to show key links between innovation
criteria and the pressures for change and development in social services to identify
future developmental trends and to link key aspects of innovation with current and
future challenges which are driving innovation and social change
Key issues relating to the trends are developed in the report These will be tested
through the selection of innovation case studies illustrating a range of practices
from across Europe to inform a Europe-wide consultation process with key
stakeholders to identify issues gaps demands and indications for further research
on innovation in social services in Europe
5
1 Background identifying and developing innovation trends and criteria
This report identifies theoretical trends and criteria for innovative service
development practices in social services developed by the INNOSERV project as part
of the second work package The trends and criteria have been formed into a
criteria framework to be used in later work packages to inform the choice of project
case studies The purpose of the INNOSERV work programme is to identify the
innovation phenomena potentials and processes important to future research
around innovation in social services
The report draws on the INNOSERV Work Package 1 literature review (Crepaldi et al
2012) which discusses concepts definitions criteria and the content of innovation
in social services plus the work undertaken to identify innovative social services in
Work Package 3 This report builds on that work in order to identify theoretical
trends and criteria for investigating and categorising innovative practices
11 Framework development
This framework and analysis have been developed through the following processes
1 The criteria development draws heavily on the work undertaken within the
INNOSERV Work Package 1 literature review which describes concepts
definitions criteria and content of innovation and on work for the process of
collection of innovative practices within Work Package 3 The latter work
which began in February 2012 developed initial types and criteria for
assessing innovation These are given in full in the report of that work
package and are shown in an abbreviated form in Appendix 1 of this report
2 Eleven partner organisations and a member of the advisory board took part
in a teleconference discussion concerning aspects of criteria development in
March 2012 This identified the key research questions for Work Package 2
as
a What changes in social political economic and technological
development are driving changes in social services (see point 22 in
WP2 description)
b What types of innovation developments are being used in responding
to these changes (see point 23 in WP2 description)
3 Further literature research was undertaken in order to identify specific issues
relating to current societal challenges which act as driving forces for social
service innovation and to place innovation in social services within a dynamic
theoretical context
4 The Consortium members took part in a scenario planning exercise to
assess societal challenges which are driving forces for innovation in social
services now and into the future The results of this exercise were discussed
at a Consortium meeting in June 2012
5 Work packages 3 and 4 were managed through a parallel process all of the
first four work packages influencing each other
6 Criteria for the analysis of innovation were agreed at the Consortium meeting
and the framework developed
7 The criteria were then used for the final selection of projects which is
reported in Work Package 4 (Eurich and Strifler 2012)
6
This report draws very much on the contribution of all the partners although
responsibility for writing it lies with the University of Southampton UK
The report begins with a brief review of the background theoretical concepts
relating to how innovation developments can be understood against knowledge and
practice development in social services It goes on to present the INNOSERV criteria
framework and to explore each of its components
2 Innovation service development and social change paradigm
development and service development
The assessment and understanding of innovation in social services takes place
within a number of organisational and cultural contexts
Our understanding of what is normal and what is new informed by
o Cultural assessments of what is safe and a reliance on lsquoconfirmedrsquo or
accepted knowledge
o The capacity to take risks and try out new ideas in practice or apply an
existing idea in a new situation creating new outcomes
The legal and political environments in which services are developed and
whether they promote adoption of new ideas and practices
In the area of social services these kinds of developments are embedded in a
number of sociologically derived factors including
Local social power structures
Economic capacity or constraint
Political ideologies
Professional ideologies and expertise
These variously integrate into a number of understood social lsquoparadigmsrsquo which
support or inhibit innovatory change Paradigms can support change by enabling
innovative developments to occur to improve the quality or functioning of social
systems within the prevailing paradigm These paradigms can also inhibit thinking
and action which might challenge the fundamental basis of the paradigm
A number of innovative developments can also accumulate in a system and which
collectively begin to challenge the basis for the paradigm itself These may support
the shift into a new social paradigm and inform influence and even radically alter
the way social systems work and develop
An example of this in practice is how the understanding and legal acceptance of
equality for people with disabilities particularly learning disabilities grew from a
number of innovative developments
lsquoNormalisationrsquo (Wolfensburger 1975) proposed that society should include
people with disabilities within the range of normal human existence
The de-institutionalisation of care which can for example be traced to
people with learning disabilities being supported to live in ordinary domestic
settings rather than specialist hospitals in British Columbia Canada
alongside other similar development in other settings
The lsquoindependent livingrsquo movement through which people with disabilities
argued that they should manage their social supports to meet their own
7
personal objectives rather than accept the standardised offerings of social
services organisations
The development of a lsquosocialrsquo rather than lsquomedicalrsquo model for how disability
should be described and understood
Each of these was an innovation some more challenging to the prevailing lsquocarersquo
paradigm than others During the last years of the 20th
century together they
accumulated to deliver a change in the fundamental paradigm informing most
European social systems so that what became an lsquoequalitiesrsquo based framework now
underlies the basis for these social systems (See for example Oliver 1990)
In practice of course these developments occurred simultaneously and in different
places The lsquoequalitiesrsquo arguments developed in the political domain at the same
time and informed and were informed by the practical innovations The
accumulation of the ideas to challenge legal frameworks and care systems occurred
in different ways in differing national contexts The pace of such changes taking
place in Eastern European countries now seeking to adopt these ideas in a single
often politically driven change illustrates an extreme form of lsquoinnovationrsquo adoption
This kind of development reflects processes of knowledge development identified
by Kuhn (1962) as lsquoscientific revolutionrsquo Kuhn noted that developments can occur
within what he calls lsquonormal sciencersquo until individual discoveries appear to challenge
the prevailing paradigm Some accommodations are often then made to the
paradigm but then once enough discoveries appear to challenge the basis of the
prevailing paradigm a new model has to be formed to accommodate the
discoveries lsquoNormalrsquo science can then resume within the new paradigm until this is
then in turn challenged The generation of a new paradigm also creates the
opportunity for new hypotheses which can be tested to form an expanded range of
ideas and knowledge These theories are complex and have developed a number of
critical channels for understanding how knowledge development is shaped or
limited For example some paradigm frameworks disable discovery by forcing a
rigid linguistically determined structure on knowledge development which disables
or actively prevents discovery (see for example Lakatos and Musgrave 1970)
This approach helps to understand how innovative developments in social services
relate to models of social change (see for example Sullivan 1987) Innovations can
occur within social systems but then accumulate to create or require a new social
model for social services The new social lsquomodelrsquo then generates a number of
innovations within the new framework so the equalities based social systems for
people with disabilities continue to generate for example new ideas in
employment for people with disabilities as a part of the lsquoindependent livingrsquo
concept
Innovation development therefore takes place in a dynamic environment Social
services innovations are informing social change and vice versa In order to identify
future innovation trends in social services it is important to understand how
changes in wider society will generate demands for and the development
space for innovation in social services
social services innovation will itself generate new opportunities for social
change
Using this kind of theoretical underpinning this report draws on the INNOSERV
innovation criteria developed in Work Package 1 and reviews the impact of key
societal changes to identify a set of relevant theoretical trends
8
3 Developing and defining innovation criteria
A review of the INNOSERV Work Packages 1 - 3 was undertaken at a meeting of
consortium members in June 2012 The INNOSERV Work Package 1 literature review
(Crepaldi et al 2012) identified a variety of definitions of innovation in services
service innovation and social innovation The literature review provided a first
working definition of innovation in social services shown in box 1 below and also
identified an extensive list of criteria for innovation which is included as appendix
2 This Work Package (2) contributes analysis of the key social challenges driving
innovation in social services Work Package 3 involved the collection of innovative
practice examples using some initial categorisation of innovation (see appendix 1)
BOX 1 INNOSERV first working definition of innovation in social services Innovation in social services can be defined as a type of social innovation process Innovation of social services is delivering services in another way as an answer to current and future challenges in society It mainly concerns (i) designing and implementing new social services to face new needs or unmet needs (ie types of services offered to face autism migrants with an irregular status violence against women) (ii) introducing new social services (or new mechanisms or practices) new interfaces with clients or new practices in social work in pre-existing social services Novelty improvements (effectiveness and efficiency) and sustainability are only first set of criteria to identify innovation in social services Values and the socio-cultural foundations of innovations in the social sphere should be considered Firstly in dealing with social services 1 respond lsquoto pressing social demands which are not addressed by the market and are directed to vulnerable groups in societyrsquo 2 address societal challenges at a level in which the boundary between social and economic blurs and societal challenges are directed towards society as a whole 3 generate systemic changes in changing attitudes and values strategies and policies organisational structures and processes delivery systems and services (Europe 2020 strategy Executive Summary EC) Social services innovations can be considered as ways to enhance processes and the outcome of social innovation Secondly situating social services within a social innovation framework means to focus on ways processes and mechanisms activated by social services that are able (a) to cope with more pressing social needs (b) to stimulate new solutions mobilizing peoples creativity and connecting people ideas and resources to a context of limited resources and rising costs (c) to be able to see social challenges also as opportunities (EC 2010 Murray Caulier-Grice Mulgan 2010) Crepaldi et al 2012 25-26
9
Following the review of these work packages the key elements of innovation for the
INNOSERV project were identified as
relevance to current and future societal challenges
type of innovation response
novelty
improvement
sustainability
context of innovation
These elements were incorporated into the INNOSERV criteria framework developed
to link these key innovation elements together The framework is shown in box 2
Box 2 The INNOSERV criteria framework linking aspects of innovation
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
10
The core of the framework focuses on the ways in which key innovations respond to
drivers and challenges It links distinct types of innovation criteria First there are
those criteria which together define innovation type of innovation or response
novelty and hallmarks of innovation including context improvement and
sustainability Linked to these are drivers or key societal challenges driving
change in social services and other challenges prompting innovation
The remaining sections of this report provide a rationale and explanation of each of
these five separate aspects that make up the framework along with definitions and
explanations of the individual elements within each to provide an analysis against
which the remaining developmental phases of the Innoserv programme can be
assessed
31 Innovation responses innovation in practice
The INNOSERV Work Package 1 literature review and collection of examples has
helped to explicate innovation operating at different lsquolevelsrsquo within service systems
The levels identified in the literature review are shown in summary form in Box 3
and are provided in full including examples in appendix 2
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
11
From this five types of response are detailed within the INNOSERV criteria
framework new service new form of delivery new form of governance new form of
resourcing and new way of evaluation The meaning of these five levels is provided
in table 1 and examples are given to illustrate this It should be noted that the
levels of response are not necessarily exclusive and a specific practice innovation
may fall into more than one category
Box 3 identified levels of innovation in social services
organizational level (ie organization of the provision of social services
type of service target group delivering logics)
regulatory and legislative level (lsquohow services are regulated organised
provided and financed the modalities of service provision the types of
relationships between external service providers and public authoritiesrsquo
EC 2006 p 8)
organizational level ndash connection and cooperation (partnership
networks governance)
professional level (social work methods and practices) -
users level
conceptual level and values
public policy level (policy framework programs and social policies)
financial and economic sustainability level (and scaling-diffusion-
transferability of innovation)
evaluative level and attention to quality (quality standards)
Crepaldi et al 2012 98-99
12
Table 1 Levels of response
Response Definition Example
New service New or improved
product of the scheme
or process
Personalised instead of
generic service
New form of delivery New or improved means
by which the outcome is
achieved
Self-help or social enterprise
instead of government agency
New form of
governance
New or improved way
the scheme or process is
managed and where it
draws authority from
Co-operative or user managed
instead of public service
New form of
resourcing
New or improved
financial human or
physical inputs to the
scheme or process
Grant-funded collectively
staffed organisation instead of
professionally managed
government agency
New way of
evaluation
New or improved
parameters by which
success is judged
User assessment of
effectiveness instead or
professional determined
criteria
It is important to note that innovation within a service is more challenging to define
and measure than innovation in the sense of a product (OECD 2005) while a
product is a tangible entity innovation within service provision can be a either a
product or a process and can occur at different levels of service provision and there
are a number of potential complexities which may inform the structure set out in
table 1
Phills et al (2008) for instance state that social innovation can be
ldquoa product production process or technology (much like innovation in
general) but it can also be a principle an idea a piece of legislation a social
movement an intervention or some combination of themrdquo (39)
In discussing public sector services Hartley (2005) emphasises that innovation is
ldquonot just a new idea but a new practicerdquo (27) and argues therefore that definitions
need to recognise practical impact For services this impact might be at one of
several levels
The organisation literature on innovation offers the initial distinction between
product and process innovation to which other types of innovation have been
added such as position and paradigm innovation (Tidd and Bessant 2009) For
social service oriented innovation further types are added
For example Hartley (2005) identifies the levels of product service process
position strategic governance and rhetorical innovations Hochgerner (2011) adds
social types of innovation to include roles relations norms and values
13
Osborne and Brown (2005) critique a number of typologies to classify innovation
from the management literature They point out that the dichotomy between
process and outcome makes them alternatives whereas an innovation and
particularly innovation in services can be both With services there is often not a
distinct separation between product and process with production delivery and
consumption of services often occurring simultaneously (OECD 2005)
32 Novelty
The next aspect is innovation is novelty In terms of novelty a three way
categorisation is proposed for INNOSERV new perspectives on old needs or
problems new practices for old needs or problems a new practice for a new need
The categorisation reflects the need for innovation to address both existing needs
and new needs Again there is much discussion in the literature about novelty in
relation to innovation Two points are addressed which can be summarised as
lsquowhat degreelevel of novelty equates to innovationrsquo and lsquonew to whomrsquo
The first distinction to be made is between different levels of innovation
ldquoThere are degrees of noveltyrunning from minor incremental
improvements right through to radical changes which transform the way we
think about and use them Sometimes these changes are common to a
particular sector or activity but sometimes they are so radical and far-
reaching that they change the basis of societyhelliprdquo (Tidd and Bessant 2009
27)
Tidd and Bessant usefully break down the incremental-radical continuum as lsquodoing
what we do betterrsquo lsquonew to the enterprisersquo and lsquonew to the worldrsquo (Tidd and
Bessant 2009 38)
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
14
While for some writers a change must be radical or pattern breaking in order to be
innovation it has been argued that within services innovation can be small
adjustments (Fuglsang 2010) Fuglsang in fact argues for a view of innovation in
public sector services as a process of building of skills and expanding routines (68)
The second part of the argument lsquonew to whomrsquo is whether innovation relates to
absolute first use A common to view of innovation is not just those elements
developed within an institution but also those adopted from others (for example
see OECD (2005) for business sector innovation Phills et al (2008) regarding social
innovation Hartley (2005) and Koch (2005) in relation to innovation in public
services) Phills et al (2008) for example state
ldquoAlthough innovations need not necessarily be original they must be new to
the user context or applicationrdquo (Phills et al 37)
Osborne and Brown (2005) purport that most studies consider newness as new to a
person organisation society or situation but not necessarily first use (2005 120)
The authors go on to argue that these are in fact different forms of innovation
differently termed as objective and subjective innovation (Kimberly 1981) or
intrinsic and extrinsic innovation (Downs and Mohr 1976)
Hartley (2005) expounds the dissemination and adaptation of innovation to other
contexts as particularly important for public sector services arguing that public
goals ldquocan be enhanced through collaborative arrangements to create share
transfer adapt and embed good practicerdquo (27) She terms this ldquorsquolateralrsquo innovationrdquo
(33) of good practice adoption and adaption
An example of this approach to defining innovation within social services is seen in
the UK Government policy document on innovation within the National Health
Service which states
ldquoinnovation is as much about applying an idea service or product in a new
context or in a new organisation as it is about creating something newrdquo
(Department of Health 2011 9)
15
33 Hallmarks of innovation
Within social service systems it is not sufficient to focus only on novelty as a
marker of innovation In addition the INNOSERV framework includes certain
hallmarks of innovation including assessment of context quality and sustainability
331 Contextual fit
Different innovative approaches need to fit within different service framework
contexts and need adaptation to those contexts Drawing further on the above
discussion of novelty INNOSERV employ this to mean new to a given (for example
national) context This will reflect the diversity of social service contexts within the
European Union Case studies will also consider transferability of an innovation
from one context to another
332 Improvement in quality
ldquoIn public servicesinnovation is justifiable only where it increases public
value in the quality efficiency or fitness for purpose of governance or
servicesrdquo (Hartley 2005 30)
It is commonly understood that innovation is about improvement as well as novelty
Hartley (2005) offers a model which sets out the possible relationships between
innovation and improvement These relationships are for organisations showing no
improvement and no innovation improvement but no innovation innovation but no
improvement innovation and improvement Important points to highlight from this
model relate to innovation but no improvement first that innovations may not
always lead to success and a level of failure is to be expected second that
innovation can lead to increased but undesired choice loss of performance due to
the process of learning and innovations that are ultimately of no value In terms of
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
16
what is to be measured as improvement Hartley maintains that beyond
improvements in service quality and fitness for purpose wider issues of public
value should be considered
The difficulties of measurement and evaluation of innovation in social services need
to be highlighted as the measures of success within a social project are difficult to
define (Bason 2010 Murray et al 2010) Improvement of social services can
include improved quality of life and access to economic and social opportunity
These issues may relate differently in the fields of health welfare and education
For instance quality of life within health may relate to physical health and mental
wellbeing at different stages of life within welfare issues such as equality of access
to housing cultural and community activities and employment are important
The INNOSERV case studies will include available information on the outcomes of
the innovative project although these will likely vary in terms of types of
measurement used by the projects
333 Sustainability
ldquoInnovation is not just about the originating idea but also the whole process
of the successful development implementation and spread of that idea into
widespread userdquo (Department of Health 2011)
It is recognised that change through innovation needs to be sustainable (Bereiter
2002) Achieving a sustainable innovation may involve streamlining of ideas and
altering them to work in everyday practice (Murray et al 2010 12) The
Normalisation Process Model offered by May and colleagues (May et al 2007 May
et al 2009) provides a theoretical explanation within the context of health care of
the processes through which interventions become embedded in practice and then
integrated and sustained
17
4 Drivers of innovation key societal changes
Innovation within social services needs to be relevant to key social challenges and
changes This relates to the purpose of social services in responding to pressing
social demands and societal needs It is therefore important for the INNOSERV
project to have an understanding of the key social challenges and changes driving
innovation to inform the lsquotheoretical trendsrsquo influencing future innovation
requirements As part of this work package we have therefore sought to identify
social challenges and changes which may act as driving forces of innovation and
shape the development of social service lsquoparadigmsrsquo and hence future social
change
Using a lsquoscenario planningrsquo methodology borrowed from management science can
help to test the limits to any paradigm and identify where new paradigm models
may be needed in the future This in turn should help to identify where future
research interests could be located to explore not just opportunities for innovation
within the current paradigm but also where socially driven change is creating new
opportunities (or indeed requirements) for social and social services innovation
Further these challenges feed into social service provision in terms of an imperative
to address new needs and level of need and issues of rising costs
The INNOSERV project undertook such a scenario planning process the outcomes
of which inform what follows here Using an extended literature study on future
social challenges in the European context a number of key factors promoting a
response from and requiring change in social services were identified Individual
partners made further analysis of the important social challenges within their own
national context The factors were synthesised into a table of key social challenges
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
18
(see appendix 3) separately for health welfare and education sectors although
there was much overlap in the challenges relating to each sector
Small groups involving two country based teams in each case took each social
challenge and considered how it may change and develop given current
understandings of the forces affecting change (some forces may promote change
and some may block change) These were considered against potential political
developments economic developments socialsociological change technological
development legallegislative changes and environmental factors with a focus on
volume nature depth timeframe and scale of importance in influencing future
developments in social services
This work informed extensive discussion at the INNOSERV June 2012 Consortium
meeting with regard to the impact of key future developments on innovation and
the choice of projects which should be used to test key innovation developments
and their relevance to future service development
Relevance is represented in the INNOSERV criteria framework by the lsquodriversrsquo box
which includes a number of examples The most significant social challenges and
changes which were identified by the Consortium as most pertinent to innovation in
social services are listed in table 2 (page 19) and are explored further in the
remainder of this section The selection of projects as case studies has included
analysis of which of these social challenges and changes are being addressed (see
Work Package 4 report Eurich and Strifler 2012)
41 Demographic change as a key societal change driving innovation in the
health and welfare social service sectors
Demographic change was identified as a driving force of innovation in both health
and welfare services in Europe Current demographic change is resulting in
increased numbers of people living longer into old age with a particular increase in
the numbers of people aged over 80 This is alongside a reduction in the numbers
of people of working age in part due to a declining birth rate Further socio-cultural
change is leading to concerns about levels of informal care for older people
While many people will want to live active lives in old age some will live with long
periods of ill health and will have complex care needs resulting from multiple co-
morbidities Most however prefer to live as independently as possible
Questions arise about the ability to meet these increasing care demands from
declining tax income bases In addition the specific needs of elderly patients with
dementia represent a unique challenge for nursing staff and the organisation of
nursing services Financing of the rising health care costs for public agencies or for
health insurance schemes requires sustainable solutions and structural reforms
Traditional models of hospital lsquoacutersquo care may not necessarily be appropriate for
meeting these health care needs
This all highlights the need to find alternative solutions to care needs including the
use of technology and reliance on informal carers Current responses which are
relevant to this driver include integration of health and social care services to
increase cost efficiencies use of technological solutions to enhance self care and
care at home and new paradigms such as Active Ageing
19
Table 2 Key social challenges and changes driving innovation
Social
challengesocial
change driving
innovation
Meaning Social service sector
in which driver is key
Demographic
change
Increase in numbers of over 65s Greatest
increase in over 80 age group Increase in
old age dependency ratio
Health sector
Welfare sector
Aspirations Rising expectations of citizens for better
quality of lifebetter care
Health sector
Education sector
Cross sector services of
education and health
Lifestyles Increase in certain diseases related to
obesity alcohol and drug consumption
and stress diabetes liver disease anxiety
and depression
Health sector
Cross sector services of
education and health
Technology Access to information new media
technology
Health sector
Continued
inequalities
Continued economic inequality
unemployment continued poverty
including child poverty continued
institutionalisation continued inequality for
people with disabilities ethnic minorities
gender inequalities impact of socio-
economic status on health outcomes
Welfare sector
Education sector
Cross sector services of
education and health
and welfare and
education
Independent living The approach now adopted by disabled
people to live as ordinary members of
society and in their chosen domestic
setting
Welfare sector
Social roles Changing families increase in single
households increase in single parent
families changing generational relations
(due to longer life expectancy) reduction in
extended families
Changing gender roles rising female
employment rates
Welfare sector
Education sector
Organisational
changes
Creating new organisational forms
application of more responsive
management processes performance
management culture
Welfare sector
Changing
management
styles
Application of more responsive
management processes
Education sector
Cross sector services of
education and health
20
42 Aspirations as a key societal change driving innovation for health and
for education service sectors
Citizen aspirations were identified as a key societal change acting as a driving force
for innovation within both the health and education sectors and across the
boundary of these sectors Across Europe citizens are expecting a better quality of
life including improved outcomes from health and care services and reduced
inequalities
In terms of the health service sector this both derives from and manifests itself in
a population which is more informed about health issues Consequently patients
wish to be more involved in decisions about their health and their health care
options and are more willing and able to participate in the management of their
condition There is less deference to the medical profession and greater willingness
to make demands on health services There are a growing number of patient led
movements which are challenging some medical traditions
This aspect is fundamental both to everyday practice and to the future development
trajectory for health care services While most health aspirations are limited by
current knowledge and medical skill as research and medical advance offer new
choices and opportunities but at greater costs there will be difficult questions for
political debate This could well result in very different more personalised and
lsquopatient managedrsquo models of health care support
In terms of the education service sector individualism and the connected
aspiration of lsquobeing involvedrsquo has been an increasing trend over the past years and
is expected to keep gaining importance This is not only reflected by agendas of
individually shaped curricula or learning arrangements in school but also by the
opening of the public (ie government funded) school system towards involvement
of the community (seniors in school corporate sponsoring external initiatives of
informal learning and personality formation etc) This is reflected in a similar way
in higher education (eg service learning) and adult education (lsquolearning regionsrsquo)
Across the boundary of health and education aspirations coupled with medical
advance lead to a desire for independence of disabled people and those with long
term conditions This highlights the need for health programs focussed on self
esteem
43 Lifestyles as a key societal challenge driving innovation in the health
service sector and also in the cross sector services of health and education
A key social challenge acting as a driving force for innovation for the health sector
and in the cross sector services of education and health is a recognised growth in
lsquolifestylersquo related conditions arising from unhealthy behaviours such as poor diet
alcohol consumption and smoking (although there is limited evidence of a decline
in smoking rates as its harmful effects are less well tolerated) Political investment
in public health is recognised as an important strategic ambition but often not
matched by financial resources Questions about personal responsibility are also
being asked with suggestions that people with poor health behaviours should not
be given the same priority to responsive health care services As other factors
impacting on health outcomes become more responsive to medical advance these
factors are growing in importance in their impact both on wider society and in
improving overall health outcomes
21
44 Technology as a key societal change driving innovation in the health
service sector
The growth in internet and web based technology is leading to an exponential
growth in access to information and new forms of communication More people
now use the internet as their primary health care information resource Web
lsquocommunitiesrsquo are linking and thus empowering people faced with similar health
challenges Telehealthcare solutions to on-going care needs are becoming more
widely available and are changing the patterns of demands for some health care
services Other new technologies for example in transport and in home assistance
devices are enabling greater independence for disabled people
As future generations use and expect more from access to information and
communication services health care services will have to respond to both the
demands and the opportunities created by such technology Technology can be
seen as both a driving force for innovation and as an enabler of change
45 Continued inequalities as a key societal challenge driving innovation in
welfare and education service sectors also in cross sector services of
education and health and welfare and education
Continued inequalities were identified as a key driving force for innovation within
both welfare and education sectors and in services which straddle the boundary
between education and health services and education and welfare services
Inequalities stem from issues of migration social originbackground
unemployment disability and gender and have been a source of the social
upheaval which has been seen in Europe in recent months
Within health education the link between socio-economic status and health is clear
with people from lower socio-economic groups experiencing poorer health and less
likely engaging in health promoting behaviours In the case of migrants health
messages need to be delivered in a culturally appropriate manner
46 Independent living as a key societal change driving innovation in the
welfare service sector
In terms of disability the emergence and spread of the independent living
philosophy has been a key change driving innovation in the welfare service sector
Typically innovation in this field involves new stakeholder roles with a much more
proactive role for service users in all stages of service provision design
implementation monitoring and fine tuning of services as well as a role in
coordination of different entitlementsservices andor administration and reporting
requirements The boundaries are being pushed further deeper and wider every
day Starting from persons with physical disabilities services are now promoting
active involvement of persons with severe mental disabilities a development that
was deemed impossible only 30 years ago
47 Social roles as a key societal change driving innovation for welfare and
for education service sectors
Changing social roles were identified as a key challenge driving innovation within
the welfare and education sectors These changes are within families and of the
family itself and include changing gender roles and changing family structures (eg
increase in single parent families increase in the numbers of older people living
alone) Families seem to be becoming a sphere of public or community interest
rather than an exclusively private one
Proper lsquosocializationrsquo of children is the key to building viable and sustainable
futures for individuals Early stage family intervention is necessary to prevent the
22
very emergence of conflicts lsquoExternalrsquo interventions often do not reach every day
interaction and thus the root causes of problems This is of significance for family
based projects as well as for care institutions and education providers
48 Organisational changes as a key societal change driving innovation in
welfare service sectors
The shifting of provision of services from the public sector into other sectors such
as independent profit making companies and social enterprises creates new
opportunities for innovation In addition there is an increasing move to provide
services locally in order to be more relevant and responsive and a move to
community based models of care
49 Changing management styles as a key innovation challenge for the
education service sector and in cross sector services of the health and
education sector
Connected to individualism as well as new social roles of individuals family
community and institutions management styles shaped by multi-stakeholder
involvement are gaining importance Community based models do not only increase
the complexity of players involved in the lsquovalue creationrsquo process but also the
enhancement of skill development and personality formation as well as the
fertilization of the educational landscape by innovative ideas expertise and
practices of diverse partners The latter fact also stimulates an increase in cross-
sectoral services (education health and social services) Simultaneously this
situation increases the necessity to spot choose and foster the lsquoinfluencesrsquo and
lsquocombinationsrsquo which realize the highest value through the assessment of social
impact
Increased emphasis is also being placed on illustrating and monitoring
performance Impact measurement and associated tools and practices gain
overarching importance
In terms of changing management styles within the health and education sector an
important aspect is the cooperation of different stakeholders and the involvement
of the community or userrsquos perspective Linked to increased user aspirations
people would like to take part in the development of programs and services With
their special knowledge of their condition for example they can contribute their
expertise within social services
23
5 Other key challenges driving innovation
Sociatal challenges and changes are of course only one driving force of innovation
In addition to these there are other meso and micro level factors which also drive
innovation These include research and development leading to new knowledge
professionally led innovation in response to users needs increasing costs of service
provision and demands for greater efficiency per se and specific political contexts
These other forces are included in the INNOSERV criteria framework in the
lsquochallengesrsquo box These factors are not a key focus for selection of projects for
INNOSERV as they are often very situation specific but will be noted in the case
studies where relevant The factors which prompt or trigger specific innovations
whether socially based or otherwise are not are not mutually exclusive (Bason
2010) and in there is a complex and interacting relationship between a variety of
factors for any given innovation lsquoinstancersquo In addition there are well documented
factors which act to inhibit the development of innovative responses (see Crepaldi
et al 201215)
This work package has sought to identify generic criteria and drivers but it must be
recognised that the dynamics of individual settings and local factors will impact on
the actual processes of adoption
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
24
6 Conclusions and next steps
This report has presented the framework which has been used within the INNOSERV
project to support the choice of innovative case studies and to assist in identifying
the innovation phenomena potential and processes important to future research in
this area The framework has been used to select projects as case studies (see Work
Package 4 report Eurich and Strifler 2012) The framework interlinks aspects of
innovation (novelty type context improvement sustainability) with analysis of
challenges and changes which are acting as driving forces of innovation in social
services As the project is future facing it is proposed that key social challenges
and changes are likely to inform the development of new change paradigms for the
delivery of social services across Europe The framework will inform further
development and testing of concepts through the next stages of the INNOSERVE
programme This process will result in descriptions for the key areas in which future
research on innovation in social services should be taken forward
25
7 Bibliography
Bason C (2010) Leading public sector innovation Co-creating for a better society
Bristol The Policy Press
Bereiter C (2002) Design research for sustained innovation Cognitive Studies
Bulletin of the Japanese Cognitive Society 9 321-327
Christensen CM and Overdorf M (2000) Meeting the Challenge of Disruptive
Change Harvard Business Review March-April
Clark M and Goodwin N (2010) Sustaining innovation in telehealth and telecare
WSDNA briefing paper London The Kings Fund
Crepaldi C De Rosa E And Pesce F (2012) Literature review on innovation in
social services in Europe (sectors of Health Education and Welfare
Services)INNOSERV Work Package 1 report
Department of Health (2011) Innovation Health and Wealth Accelerating Adoption
and Diffusion in the NHS London Department of Health
Eurich J and Strifler A (2012) European compared selection of innovative social
services INNOSERV Work Package 4 report
Fuglsang L (2010) Bricolage and invisible innovation in public service innovation
Journal of Innovation Economics 5 67-87
Greenhalgh T Robert G Macfarlane F Bate P Kyriakidou O (2004) Diffusion of
innovations in service organizations systematic review and recommendations
Milbank Quarterly 82581-629
Hartley J (2005) Innovation in Governance and Public Services Past and Present
Public Money and Management 25127-34
Koch P and Hauknes J (2005) On innovation in the Public Sector Publin report no
D20
Kuhn T (1962) The Structure of Scientific Revolutions Chicago The University of
Chicago Press
Lakatos I and Musgrave A (eds) (1970) Criticism and the growth of knowledge
London Cambridge University Press
May
C Finch T Mair F et al ( 2007) Understanding the implementation of
complex interventions in health care the normalization process model BMC Health
Services Research 2007 7148 doi1011861472-6963-7-148
May et al (2009) Implementing Embedding and Integrating Practices An Outline of
Normalization Process Theory Sociology 43 535-554
Murray R Caulier-Grice J and Mulgan G (2010) The Open Book of Social
Innovation London The Young Foundation
26
OECD (2005) Oslo manual Guidelines for collecting and interpreting innovation
data 3rd
edition
Oliver M (1990) The politics of disablement Basingstoke Macmillan Education Ltd
Osborne S (1998) Naming the Beast Defining and Classifying Service Innovations
in Social Policy Human Relations 51 9 1133-1154
Osborne S and Brown K (2005) Managing Change and Innovation in Public Service
Organizations London Routledge
Phills JA Deiglmeier K and Miller DT (2008) Rediscovering Social Innovation
Stamford Innovation Review 6 4 34-43
Sullivan M (1987) Sociology and Social Welfare London Allen and Unwin
Tidd J and Bessant J (2009) Managing Innovation Integrating Technological
Market and organizational Change 4th
edition Chichester John Wiley and Sons
UK Government Department of Health (2011) Innovation Health and Wealth
Accelerating adoption and diffusion in the NHS London Department of Health
Wolfensburger W (1975) The principle of normalisation in human services Toronto
National Institute on Mental Retardation
27
8 Appendices
Appendix 1 Summary of types and criteria of innovation used in Work Package
3 to identify practices
Identification of social service
Field(s) of service
Logic(s) of service
Self help or mutual aid logic Social care logic Multi-stakeholders logic Social
movements logic Combination
Activities of services delivered
Assistance for persons faced with personal challenges or crises (debt unemployment
drug addiction other) (Re)integration of persons into society (rehabilitation language
training for immigrants other) Services to the labour market (occupational training)
Social housing for disadvantaged groups Care (for the elderly children families )
Treatment and support of people with physical illnesses Treatment and support of
people with mental health problems Combination
Status of the provider organization
Public organization (governmental) Private organization ndash nonnot for profit Private
organization ndash profit Volunteer association Cooperative company or mutual company
Familyneighbourhood Civil society network Combination Other
Target group
Children Youngsters Elder people Unemployed people Poor people Immigrants
Disabled people People with chronic diseases ndash long-term health problems People with
acute or short term health problems No specific target group (eg territory-based social
services provision aiming at strengthen social ties) Combination Other
Size of the organization
Innovation
Type of innovation
New forms of organization resources hybridization new targeted actions new services
non-structural practices other
Innovative character
do the service practices appear to be something new in the field of social services
Origins of innovation
Supply side demand side broader operating factors
Impact on service performance
Effectiveness of service delivery
from user perspective cost effectivenesscapacity building sustainability of
innovation
Quality of provision
28
Socialization quality of life as judged by users and beneficiaries more inclusion
lower risk on exclusion participation of the user transition from institutional to
community based care
Potential wider effects
Promoting social and health equality sustainability new skills and jobs
increased social rights affordability of adequate and high quality health and long-
term care promotion of equality and non-discrimination equal access to adequate
provision
Transferability of innovations between national contexts
29
Appendix 2 levels of innovation identified within INNOSERV Work Package 2
literature review
Organizational level (policy organizational sectors)
New social services designed to face new needs or unmet needs
Search for new solutions to old needs new mechanisms or practices introduced in
preexisting
social services
to improve access to social services (ie more information increased
professionalism in
social work sector)
to guarantee entitlements (rights) for specific groups or minorities
to satisfy the demand for social services in a more complete and broad way
(holistic
approach)
to guarantee more participation and inclusion of citizens
New and increased Cross-Sectoral social services
Cross-Sectoral social services (ie teaching art to children while helping their mothers
for
job seeking and offering jobs for young artists)
Integrated care practices
Tearing down walls between sectors and the role of informal care
Sharing of knowledge
Better integration of Health and Social sector services
Territory based social services that contribute to the creation of training and job
opportunities for disadvantaged people
Solidarity-based social services
Social mediation for impaired and weakened people
Easy access to housing for poor families
New interfaces with clients
Logic(s) of service Self help or mutual aid logic Social care logic Multi-stakeholders
logic
Social movements logic
The development of the self-help sector
Actors New organizations (Cooperative society for social service provision ndashSCOP
Cooperative society as social enterprise with userrsquos involvement ndashSCIC)
New legal forms within structured public frameworks (Italy social cooperatives)
New provider organizations and existing organisations refashioned by new dynamics
New roles and relations among actors
New private organizations for profit and non-profit
Management style in the organization
Regulatory and legislative level
New architecture of the provision system
Socially responsible public contracts and social clauses (outsourcing)
Adherence to EU standards in transitional economies
Impact on institutional framework that shape innovation in social services
New arrangement between one or more government agencies andor external
organization
Organizational level ndash Connection and Cooperation (governance and partnership)
New networks and social movements established in order to design deliver and
finance
social services
Cooperation between sectors actors and different forms of provision
Cooperation between local actors
Increasing communication responsiveness
30
Utilizing connectivity and interdependencies
Modification of organizational systems (models of governance work organisation
number
of involved stakeholders in governance)
Public sector and local authorities as promoters of innovation and promoters of
crosssectoral
policy strategies
Third sector and user as promoters of innovation
Volunteer workers and initiatives launched by a group of citizens
Third sector and userrsquos engagement design (co-design and re-design services)
Joint decision process
Decision-making power not based on capital ownership
Employee and user driven innovation
Partnerships with users family carers and user organizations
Partnership between service users practitioners and academics
Community-based and participative health network in a local territory
Collaboration between public and volunteer organisations (NGOs) or between civil and
local
networks in collaboration with public organisations and social enterprises
New techniques for partnership building and functioning
Impact on social and power relations
Professional level (practitioners)
New practices in social work
Innovative tools (ie Theatre of the Oppressed) and the use of participated methods in
social
work (ie self-help group)
Networking
Individualised supports
New professional skills in social work
The use of informatics and new technologies in social work
Users
Participation and involvement of final users of services in designing delivering and
evaluating social services
Involvement of final users in promoting equality effectiveness and control and
adherence
to the needs of users
Conceptual Level (and value)
New models of society - Social goals participation user involvement community
benefit
New paradigms underlying a new social service concept or service delivery model (ie
new
inclusion paradigm active ageing)
Relationships and trust
Pursuing diversity
Better adjustment to usersrsquo needs more person centred support
More social services provision in less developed regions
New concept of accessibility of the service (ie for Roma families)
The concept of lsquoprogressive universalismrsquo
The Social Care Model
De-institutionalization and community care Improved home-based and community
services
Gender and diversity perspectives
Anti-discrimination and equality process
Increase of the level of recognition of social values objectives paradigms and goals
New models of interaction leading to social innovation processes
31
Public policy level (policy framework programs and social policies)
The new role of the system governance played by central (or local depending on
national
arrangements) government
Impact on public policies new public policy programme measure or intervention
Joint construction of a space for public action and redefinition of public governance
bodies
and methods
Innovative logics for public policies
Innovating the public sector
The new wide attention on anti stigma policies
E-government
Financial and economic sustainability level (and scaling-diffusion-transferability
of innovation)
New ways to overcome budgetary constraints
New approaches to acquire funding
The involvement of private investors
The introduction of special funds
The purchase of innovative practices by final users
Hybridization of resources (market redistribution and reciprocity resources)
New investment sources
Mobilising community resources taking full advantage of all endogenous resources
Improvement in efficiency and effectiveness
Financial and systemic sustainability Impact on the economy
Economic Environmental and Social Sustainability of Territory based social services
Financial tools necessary to territorial social initiatives and the way to unlock them
Capacity of spreading and diffusion
Evaluative level and attention for quality
Affordability availability and accessibility
New standards expected
New feedback loops from users and specialists
Social services of excellence as for quality efficiency and efficacy
New methods and creative tool-kits to strengthen and renew the quality of social care
services
Low-cost (for user) and high level quality of social services
Quality assurance moderation and accreditation mechanisms
New tools for monitoring social services - hearing all voices (users organizations
practioners staff family and friends)
Action research
Alternative economic and social indicators
Social impact and contribution of innovation in social services to social innovation and
social change ndash Assessment of innovation
Learning approach to evaluation ndash lsquoto learn from failuresrsquo
Developmental evaluation
Specifics for the Health sector
Disability from rehabilitation to integration and then to inclusion
Mental Health from segregation to inclusion and community care
HIV from segregationstigmatization to awareness campaigns for promoting self
protection
Innovation in the area of prevention of treatment and in the introduction of new
technologies
Emphasis on an inter-sectoral controlled and steered care in managed care models
replacement of the traditional insurance model
Integrated services
Technological progress
32
Specifics for the Education sector
Inclusive education
Inclusive education and training in collaboration with the civil society
Multicultural education
Integration of disciplines
Alternative schools non-regular schools and informal education
Link between formal and informal education
Community development based approaches
Connection between regular school and the system of social services
Experiential learning
Human rights education
Working lsquothrough relationshipsrsquo with children and young people
Problem based learning methodology
The lsquomedia educationrsquo The use of comics
ICT in schools
E-inclusion
Networks of schools
Improve supplement reinvent and transform learning
Sustained educational improvement
Learning Beyond the Classroom
Spreading a culture that values learning
More personalized approaches to learning
Using the web
Learning with and by not to and from
33
Appendix 3 analysis of social challenges and changes driving innovation
Welfare
Societal
change as
driving force
of innovation
in social
services
Meaning
description
Related
outcomesother
factors
Examples of innovative
responses
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
Empowerment self-
determination choice
The lsquoassertive userrsquo
Demand for more
individualised services of
better quality
Alternativecomplementary
providers
Personalisation
Co-production (new
userprofessional
relationships)
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demand on services
Potential for poor access
to services (from
communication
problems social
isolation)
Multiculturalism
Integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Declining female
caregiving
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
34
Increased demand for
services demand for
formal care
Continued
inequality
Continued
economic
inequality
unemployment
continued poverty
including child
poverty continued
institutionalisation
continued
inequality for
people with
disabilities ethnic
minorities gender
inequalities
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients
with complex
comorbidities increase
in certain diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing demand for
services Increasing
costsneed to make
limited resources go
further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
Decisions about value
marketization
Technological
development
Access to
information new
media technology
Facilitates self
determination increases
expectations and choice
population better
informed about
conditionsservicesright
s and less deferential
Users better able to
35
mobilise
Increased exclusion of
some groups with limited
access
New models of remote
care provision
Ability to exchange
information on quality
and experience
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Increasing costs
Decisions about value
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Organisational
change changing
management
styles
philosophies
Creating new
organisational
forms application
of more responsive
management
processes
performance
management
culture
Integration of
organisationsfunctions
new approaches to
lsquocommissioningrsquo of
organisationsservices
distortions caused by
lsquolocked inrsquo expenditures
(tertiary health care
residential care)
Decentralisation
deinstitutionalisation
marketization liberalisation
The lsquoenabling
statersquo Political
will fiscal space
Impact of financial
crisis competing
priorities for public
funds
Legacy of category-based
(not needs based) social
protection structural
transition
deindustrialisation
Health
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
EmpowermentSelf-
determination choice
Demand for more
individualised services of
better quality
Users better able to mobilise
Assertive lsquouserrsquo
knowledgeable patient
Alternativecomplimentary
providers
36
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demands on
services
Potential for poor access
to services (from
communication
problems social
isolation)
MulticulturalismTrained
health professionals
move to richer countries
integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Declining female
caregiving
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
Increased demand for
formal care services
Continued
inequalities
Unequal
distribution of
health risks and
health
outcomediseases
by socioeconomic
indicators
Unequal access to
care by social
status geography
gender and
ethnicity
Demographic Increase in
numbers of over
Increase in patients with
complex comorbidities
Increasing demand for care
Decisions about value Active
37
change 65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing costsneed to
make limited resources
go further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
ageing paradigm
Technological
development
Access to
information new
media technology
Self determination
expectations choice
population better
informed about
conditionsservicesright
s and less deferential
Ability to exchange
information on quality
and experience
New models of care provision
(eg telehealth care) new
health management systems
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Changing
management
stylesphilosophi
es
Application of
more responsive
management
processes
Decentralisation
deinstitutionalisation
marketization liberalisation
Lifestyle changes Increase in certain
diseases related to
obesity alcohol
and drug
Increasing
costsdemands for care
38
consumption and
stress diabetes
liver disease
anxiety and
depression
Education
Aspirations Rising expectations
by citizens for
better quality of
life
Self determination
choice consumerism
Education outside of formal
setting
Assertive user
Lifelong learningeducation
Migration Historical (post
colonial) migration
pan-EU migration
refugees
New needs for education
eg language and culture
Inequalities social
fragmentation
Social Roles Changing family
structure increase
in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
changing gender
roles rising
female
employment rates
Need to reconcile work
and family life
Parentingfamily skills
for vulnerable
parentsfamilies
Socialization of children
ndash social and emotional
deficits for children in
some environments
Work with families and
communities
Continued
inequalities
Inequality in
educational
accessattainment
by socioeconomic
status gender
people with
disabilities ethnic
minorities
Culture of failure
Promise to deliver social
mobility and economic
improvement
(Leadbeater and Wond
2010 pp 5-20)
Inclusive and multicultural
education
Differential support for
children from
lsquodisadvantagedrsquo
backgrounds
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients with
complex comorbidities
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
New group of older
39
learners
Technological
advance
Access to
information new
media technology
making learning
available in new
ways
Self determination
expectations choice
lsquoAssertive userrsquo
Increased exclusion of
some groups with limited
access
Changing
management
styles
philosophies
Community based models
Globalization Need to provide
educationtraining
which is suited to
modern knowledge
based global
economies
This report for the InnoServ project (grant agreement nr 290542) is supported
under the Socio-economic and Humanities Programme of FP7
Chris Hawker
Faculty of Health Sciences University of Southampton Building 67 University Road Highfield Campus Southampton SO17 1BJ
Tel +44 (0)23 8059 7968
Email CHawkersotonacuk
2
Contents
Summary 4
1 Background identifying and developing innovation trends and criteria 5
11 Framework developmenthelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip5
2 Innovation service development and social change paradigm development and
service development 6
3 Developing and defining innovation criteria 8
31 Innovation responses innovation in practicehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip10
32 Noveltyhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip13
33 Hallmarks of innovationhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip15
331 Contextual fit 15
332 Improvement in quality 15
333 Sustainability 16
4 Drivers of innovation key societal changeshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip17
41 Demographic change as a key societal change driving innovation in the
health and welfare social service sectors 18
42 Aspirations as a key societal change driving innovation for health and for
education service sectors 20
43 Lifestyles as a key societal challenge driving innovation in the health
service sector and also in the cross sector services of health and education 20
44 Technology as a key societal change driving innovation in the health
service sector 21
45 Continued inequalities as a key societal challenge driving innovation in
welfare and education service sectors also in cross sector services of education
and health and welfare and education 21
46 Independent living as a key societalchange driving innovation in the
welfare service sector 21
47 Social roles as a key societal change driving innovation for welfare and for
education service sectors 21
48 Organisational changes as a key societal change driving innovation in
welfare service sectors 22
49 Changing management styles as a key innovation challenge for the
education service sector and in cross sector services of the health and
education sector 22
5 Other key challenges driving innovationhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip23
6 Conclusions and next steps 24
7 Bibliography 25
3
8 Appendices 27
Appendix 1 Summary of types and criteria of innovation used in Work Package 3
to identify practiceshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip27
Appendix 2 levels of innovation identified within INNOSERV Work Package 2
literature reviewhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip29
Appendix 3 analysis of social challenges and changes driving innovationhelliphelliphellip33
4
Summary
This report identifies theoretical trends and criteria for innovative service
development practices in social services developed through the INNOSERV project
and based on
The Innoserv WP1 Report
A further review of the relevant literature
Inputs from consortium members particularly at a two day workshop held in
June 2012
The INNOSERV criteria framework is used to show key links between innovation
criteria and the pressures for change and development in social services to identify
future developmental trends and to link key aspects of innovation with current and
future challenges which are driving innovation and social change
Key issues relating to the trends are developed in the report These will be tested
through the selection of innovation case studies illustrating a range of practices
from across Europe to inform a Europe-wide consultation process with key
stakeholders to identify issues gaps demands and indications for further research
on innovation in social services in Europe
5
1 Background identifying and developing innovation trends and criteria
This report identifies theoretical trends and criteria for innovative service
development practices in social services developed by the INNOSERV project as part
of the second work package The trends and criteria have been formed into a
criteria framework to be used in later work packages to inform the choice of project
case studies The purpose of the INNOSERV work programme is to identify the
innovation phenomena potentials and processes important to future research
around innovation in social services
The report draws on the INNOSERV Work Package 1 literature review (Crepaldi et al
2012) which discusses concepts definitions criteria and the content of innovation
in social services plus the work undertaken to identify innovative social services in
Work Package 3 This report builds on that work in order to identify theoretical
trends and criteria for investigating and categorising innovative practices
11 Framework development
This framework and analysis have been developed through the following processes
1 The criteria development draws heavily on the work undertaken within the
INNOSERV Work Package 1 literature review which describes concepts
definitions criteria and content of innovation and on work for the process of
collection of innovative practices within Work Package 3 The latter work
which began in February 2012 developed initial types and criteria for
assessing innovation These are given in full in the report of that work
package and are shown in an abbreviated form in Appendix 1 of this report
2 Eleven partner organisations and a member of the advisory board took part
in a teleconference discussion concerning aspects of criteria development in
March 2012 This identified the key research questions for Work Package 2
as
a What changes in social political economic and technological
development are driving changes in social services (see point 22 in
WP2 description)
b What types of innovation developments are being used in responding
to these changes (see point 23 in WP2 description)
3 Further literature research was undertaken in order to identify specific issues
relating to current societal challenges which act as driving forces for social
service innovation and to place innovation in social services within a dynamic
theoretical context
4 The Consortium members took part in a scenario planning exercise to
assess societal challenges which are driving forces for innovation in social
services now and into the future The results of this exercise were discussed
at a Consortium meeting in June 2012
5 Work packages 3 and 4 were managed through a parallel process all of the
first four work packages influencing each other
6 Criteria for the analysis of innovation were agreed at the Consortium meeting
and the framework developed
7 The criteria were then used for the final selection of projects which is
reported in Work Package 4 (Eurich and Strifler 2012)
6
This report draws very much on the contribution of all the partners although
responsibility for writing it lies with the University of Southampton UK
The report begins with a brief review of the background theoretical concepts
relating to how innovation developments can be understood against knowledge and
practice development in social services It goes on to present the INNOSERV criteria
framework and to explore each of its components
2 Innovation service development and social change paradigm
development and service development
The assessment and understanding of innovation in social services takes place
within a number of organisational and cultural contexts
Our understanding of what is normal and what is new informed by
o Cultural assessments of what is safe and a reliance on lsquoconfirmedrsquo or
accepted knowledge
o The capacity to take risks and try out new ideas in practice or apply an
existing idea in a new situation creating new outcomes
The legal and political environments in which services are developed and
whether they promote adoption of new ideas and practices
In the area of social services these kinds of developments are embedded in a
number of sociologically derived factors including
Local social power structures
Economic capacity or constraint
Political ideologies
Professional ideologies and expertise
These variously integrate into a number of understood social lsquoparadigmsrsquo which
support or inhibit innovatory change Paradigms can support change by enabling
innovative developments to occur to improve the quality or functioning of social
systems within the prevailing paradigm These paradigms can also inhibit thinking
and action which might challenge the fundamental basis of the paradigm
A number of innovative developments can also accumulate in a system and which
collectively begin to challenge the basis for the paradigm itself These may support
the shift into a new social paradigm and inform influence and even radically alter
the way social systems work and develop
An example of this in practice is how the understanding and legal acceptance of
equality for people with disabilities particularly learning disabilities grew from a
number of innovative developments
lsquoNormalisationrsquo (Wolfensburger 1975) proposed that society should include
people with disabilities within the range of normal human existence
The de-institutionalisation of care which can for example be traced to
people with learning disabilities being supported to live in ordinary domestic
settings rather than specialist hospitals in British Columbia Canada
alongside other similar development in other settings
The lsquoindependent livingrsquo movement through which people with disabilities
argued that they should manage their social supports to meet their own
7
personal objectives rather than accept the standardised offerings of social
services organisations
The development of a lsquosocialrsquo rather than lsquomedicalrsquo model for how disability
should be described and understood
Each of these was an innovation some more challenging to the prevailing lsquocarersquo
paradigm than others During the last years of the 20th
century together they
accumulated to deliver a change in the fundamental paradigm informing most
European social systems so that what became an lsquoequalitiesrsquo based framework now
underlies the basis for these social systems (See for example Oliver 1990)
In practice of course these developments occurred simultaneously and in different
places The lsquoequalitiesrsquo arguments developed in the political domain at the same
time and informed and were informed by the practical innovations The
accumulation of the ideas to challenge legal frameworks and care systems occurred
in different ways in differing national contexts The pace of such changes taking
place in Eastern European countries now seeking to adopt these ideas in a single
often politically driven change illustrates an extreme form of lsquoinnovationrsquo adoption
This kind of development reflects processes of knowledge development identified
by Kuhn (1962) as lsquoscientific revolutionrsquo Kuhn noted that developments can occur
within what he calls lsquonormal sciencersquo until individual discoveries appear to challenge
the prevailing paradigm Some accommodations are often then made to the
paradigm but then once enough discoveries appear to challenge the basis of the
prevailing paradigm a new model has to be formed to accommodate the
discoveries lsquoNormalrsquo science can then resume within the new paradigm until this is
then in turn challenged The generation of a new paradigm also creates the
opportunity for new hypotheses which can be tested to form an expanded range of
ideas and knowledge These theories are complex and have developed a number of
critical channels for understanding how knowledge development is shaped or
limited For example some paradigm frameworks disable discovery by forcing a
rigid linguistically determined structure on knowledge development which disables
or actively prevents discovery (see for example Lakatos and Musgrave 1970)
This approach helps to understand how innovative developments in social services
relate to models of social change (see for example Sullivan 1987) Innovations can
occur within social systems but then accumulate to create or require a new social
model for social services The new social lsquomodelrsquo then generates a number of
innovations within the new framework so the equalities based social systems for
people with disabilities continue to generate for example new ideas in
employment for people with disabilities as a part of the lsquoindependent livingrsquo
concept
Innovation development therefore takes place in a dynamic environment Social
services innovations are informing social change and vice versa In order to identify
future innovation trends in social services it is important to understand how
changes in wider society will generate demands for and the development
space for innovation in social services
social services innovation will itself generate new opportunities for social
change
Using this kind of theoretical underpinning this report draws on the INNOSERV
innovation criteria developed in Work Package 1 and reviews the impact of key
societal changes to identify a set of relevant theoretical trends
8
3 Developing and defining innovation criteria
A review of the INNOSERV Work Packages 1 - 3 was undertaken at a meeting of
consortium members in June 2012 The INNOSERV Work Package 1 literature review
(Crepaldi et al 2012) identified a variety of definitions of innovation in services
service innovation and social innovation The literature review provided a first
working definition of innovation in social services shown in box 1 below and also
identified an extensive list of criteria for innovation which is included as appendix
2 This Work Package (2) contributes analysis of the key social challenges driving
innovation in social services Work Package 3 involved the collection of innovative
practice examples using some initial categorisation of innovation (see appendix 1)
BOX 1 INNOSERV first working definition of innovation in social services Innovation in social services can be defined as a type of social innovation process Innovation of social services is delivering services in another way as an answer to current and future challenges in society It mainly concerns (i) designing and implementing new social services to face new needs or unmet needs (ie types of services offered to face autism migrants with an irregular status violence against women) (ii) introducing new social services (or new mechanisms or practices) new interfaces with clients or new practices in social work in pre-existing social services Novelty improvements (effectiveness and efficiency) and sustainability are only first set of criteria to identify innovation in social services Values and the socio-cultural foundations of innovations in the social sphere should be considered Firstly in dealing with social services 1 respond lsquoto pressing social demands which are not addressed by the market and are directed to vulnerable groups in societyrsquo 2 address societal challenges at a level in which the boundary between social and economic blurs and societal challenges are directed towards society as a whole 3 generate systemic changes in changing attitudes and values strategies and policies organisational structures and processes delivery systems and services (Europe 2020 strategy Executive Summary EC) Social services innovations can be considered as ways to enhance processes and the outcome of social innovation Secondly situating social services within a social innovation framework means to focus on ways processes and mechanisms activated by social services that are able (a) to cope with more pressing social needs (b) to stimulate new solutions mobilizing peoples creativity and connecting people ideas and resources to a context of limited resources and rising costs (c) to be able to see social challenges also as opportunities (EC 2010 Murray Caulier-Grice Mulgan 2010) Crepaldi et al 2012 25-26
9
Following the review of these work packages the key elements of innovation for the
INNOSERV project were identified as
relevance to current and future societal challenges
type of innovation response
novelty
improvement
sustainability
context of innovation
These elements were incorporated into the INNOSERV criteria framework developed
to link these key innovation elements together The framework is shown in box 2
Box 2 The INNOSERV criteria framework linking aspects of innovation
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
10
The core of the framework focuses on the ways in which key innovations respond to
drivers and challenges It links distinct types of innovation criteria First there are
those criteria which together define innovation type of innovation or response
novelty and hallmarks of innovation including context improvement and
sustainability Linked to these are drivers or key societal challenges driving
change in social services and other challenges prompting innovation
The remaining sections of this report provide a rationale and explanation of each of
these five separate aspects that make up the framework along with definitions and
explanations of the individual elements within each to provide an analysis against
which the remaining developmental phases of the Innoserv programme can be
assessed
31 Innovation responses innovation in practice
The INNOSERV Work Package 1 literature review and collection of examples has
helped to explicate innovation operating at different lsquolevelsrsquo within service systems
The levels identified in the literature review are shown in summary form in Box 3
and are provided in full including examples in appendix 2
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
11
From this five types of response are detailed within the INNOSERV criteria
framework new service new form of delivery new form of governance new form of
resourcing and new way of evaluation The meaning of these five levels is provided
in table 1 and examples are given to illustrate this It should be noted that the
levels of response are not necessarily exclusive and a specific practice innovation
may fall into more than one category
Box 3 identified levels of innovation in social services
organizational level (ie organization of the provision of social services
type of service target group delivering logics)
regulatory and legislative level (lsquohow services are regulated organised
provided and financed the modalities of service provision the types of
relationships between external service providers and public authoritiesrsquo
EC 2006 p 8)
organizational level ndash connection and cooperation (partnership
networks governance)
professional level (social work methods and practices) -
users level
conceptual level and values
public policy level (policy framework programs and social policies)
financial and economic sustainability level (and scaling-diffusion-
transferability of innovation)
evaluative level and attention to quality (quality standards)
Crepaldi et al 2012 98-99
12
Table 1 Levels of response
Response Definition Example
New service New or improved
product of the scheme
or process
Personalised instead of
generic service
New form of delivery New or improved means
by which the outcome is
achieved
Self-help or social enterprise
instead of government agency
New form of
governance
New or improved way
the scheme or process is
managed and where it
draws authority from
Co-operative or user managed
instead of public service
New form of
resourcing
New or improved
financial human or
physical inputs to the
scheme or process
Grant-funded collectively
staffed organisation instead of
professionally managed
government agency
New way of
evaluation
New or improved
parameters by which
success is judged
User assessment of
effectiveness instead or
professional determined
criteria
It is important to note that innovation within a service is more challenging to define
and measure than innovation in the sense of a product (OECD 2005) while a
product is a tangible entity innovation within service provision can be a either a
product or a process and can occur at different levels of service provision and there
are a number of potential complexities which may inform the structure set out in
table 1
Phills et al (2008) for instance state that social innovation can be
ldquoa product production process or technology (much like innovation in
general) but it can also be a principle an idea a piece of legislation a social
movement an intervention or some combination of themrdquo (39)
In discussing public sector services Hartley (2005) emphasises that innovation is
ldquonot just a new idea but a new practicerdquo (27) and argues therefore that definitions
need to recognise practical impact For services this impact might be at one of
several levels
The organisation literature on innovation offers the initial distinction between
product and process innovation to which other types of innovation have been
added such as position and paradigm innovation (Tidd and Bessant 2009) For
social service oriented innovation further types are added
For example Hartley (2005) identifies the levels of product service process
position strategic governance and rhetorical innovations Hochgerner (2011) adds
social types of innovation to include roles relations norms and values
13
Osborne and Brown (2005) critique a number of typologies to classify innovation
from the management literature They point out that the dichotomy between
process and outcome makes them alternatives whereas an innovation and
particularly innovation in services can be both With services there is often not a
distinct separation between product and process with production delivery and
consumption of services often occurring simultaneously (OECD 2005)
32 Novelty
The next aspect is innovation is novelty In terms of novelty a three way
categorisation is proposed for INNOSERV new perspectives on old needs or
problems new practices for old needs or problems a new practice for a new need
The categorisation reflects the need for innovation to address both existing needs
and new needs Again there is much discussion in the literature about novelty in
relation to innovation Two points are addressed which can be summarised as
lsquowhat degreelevel of novelty equates to innovationrsquo and lsquonew to whomrsquo
The first distinction to be made is between different levels of innovation
ldquoThere are degrees of noveltyrunning from minor incremental
improvements right through to radical changes which transform the way we
think about and use them Sometimes these changes are common to a
particular sector or activity but sometimes they are so radical and far-
reaching that they change the basis of societyhelliprdquo (Tidd and Bessant 2009
27)
Tidd and Bessant usefully break down the incremental-radical continuum as lsquodoing
what we do betterrsquo lsquonew to the enterprisersquo and lsquonew to the worldrsquo (Tidd and
Bessant 2009 38)
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
14
While for some writers a change must be radical or pattern breaking in order to be
innovation it has been argued that within services innovation can be small
adjustments (Fuglsang 2010) Fuglsang in fact argues for a view of innovation in
public sector services as a process of building of skills and expanding routines (68)
The second part of the argument lsquonew to whomrsquo is whether innovation relates to
absolute first use A common to view of innovation is not just those elements
developed within an institution but also those adopted from others (for example
see OECD (2005) for business sector innovation Phills et al (2008) regarding social
innovation Hartley (2005) and Koch (2005) in relation to innovation in public
services) Phills et al (2008) for example state
ldquoAlthough innovations need not necessarily be original they must be new to
the user context or applicationrdquo (Phills et al 37)
Osborne and Brown (2005) purport that most studies consider newness as new to a
person organisation society or situation but not necessarily first use (2005 120)
The authors go on to argue that these are in fact different forms of innovation
differently termed as objective and subjective innovation (Kimberly 1981) or
intrinsic and extrinsic innovation (Downs and Mohr 1976)
Hartley (2005) expounds the dissemination and adaptation of innovation to other
contexts as particularly important for public sector services arguing that public
goals ldquocan be enhanced through collaborative arrangements to create share
transfer adapt and embed good practicerdquo (27) She terms this ldquorsquolateralrsquo innovationrdquo
(33) of good practice adoption and adaption
An example of this approach to defining innovation within social services is seen in
the UK Government policy document on innovation within the National Health
Service which states
ldquoinnovation is as much about applying an idea service or product in a new
context or in a new organisation as it is about creating something newrdquo
(Department of Health 2011 9)
15
33 Hallmarks of innovation
Within social service systems it is not sufficient to focus only on novelty as a
marker of innovation In addition the INNOSERV framework includes certain
hallmarks of innovation including assessment of context quality and sustainability
331 Contextual fit
Different innovative approaches need to fit within different service framework
contexts and need adaptation to those contexts Drawing further on the above
discussion of novelty INNOSERV employ this to mean new to a given (for example
national) context This will reflect the diversity of social service contexts within the
European Union Case studies will also consider transferability of an innovation
from one context to another
332 Improvement in quality
ldquoIn public servicesinnovation is justifiable only where it increases public
value in the quality efficiency or fitness for purpose of governance or
servicesrdquo (Hartley 2005 30)
It is commonly understood that innovation is about improvement as well as novelty
Hartley (2005) offers a model which sets out the possible relationships between
innovation and improvement These relationships are for organisations showing no
improvement and no innovation improvement but no innovation innovation but no
improvement innovation and improvement Important points to highlight from this
model relate to innovation but no improvement first that innovations may not
always lead to success and a level of failure is to be expected second that
innovation can lead to increased but undesired choice loss of performance due to
the process of learning and innovations that are ultimately of no value In terms of
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
16
what is to be measured as improvement Hartley maintains that beyond
improvements in service quality and fitness for purpose wider issues of public
value should be considered
The difficulties of measurement and evaluation of innovation in social services need
to be highlighted as the measures of success within a social project are difficult to
define (Bason 2010 Murray et al 2010) Improvement of social services can
include improved quality of life and access to economic and social opportunity
These issues may relate differently in the fields of health welfare and education
For instance quality of life within health may relate to physical health and mental
wellbeing at different stages of life within welfare issues such as equality of access
to housing cultural and community activities and employment are important
The INNOSERV case studies will include available information on the outcomes of
the innovative project although these will likely vary in terms of types of
measurement used by the projects
333 Sustainability
ldquoInnovation is not just about the originating idea but also the whole process
of the successful development implementation and spread of that idea into
widespread userdquo (Department of Health 2011)
It is recognised that change through innovation needs to be sustainable (Bereiter
2002) Achieving a sustainable innovation may involve streamlining of ideas and
altering them to work in everyday practice (Murray et al 2010 12) The
Normalisation Process Model offered by May and colleagues (May et al 2007 May
et al 2009) provides a theoretical explanation within the context of health care of
the processes through which interventions become embedded in practice and then
integrated and sustained
17
4 Drivers of innovation key societal changes
Innovation within social services needs to be relevant to key social challenges and
changes This relates to the purpose of social services in responding to pressing
social demands and societal needs It is therefore important for the INNOSERV
project to have an understanding of the key social challenges and changes driving
innovation to inform the lsquotheoretical trendsrsquo influencing future innovation
requirements As part of this work package we have therefore sought to identify
social challenges and changes which may act as driving forces of innovation and
shape the development of social service lsquoparadigmsrsquo and hence future social
change
Using a lsquoscenario planningrsquo methodology borrowed from management science can
help to test the limits to any paradigm and identify where new paradigm models
may be needed in the future This in turn should help to identify where future
research interests could be located to explore not just opportunities for innovation
within the current paradigm but also where socially driven change is creating new
opportunities (or indeed requirements) for social and social services innovation
Further these challenges feed into social service provision in terms of an imperative
to address new needs and level of need and issues of rising costs
The INNOSERV project undertook such a scenario planning process the outcomes
of which inform what follows here Using an extended literature study on future
social challenges in the European context a number of key factors promoting a
response from and requiring change in social services were identified Individual
partners made further analysis of the important social challenges within their own
national context The factors were synthesised into a table of key social challenges
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
18
(see appendix 3) separately for health welfare and education sectors although
there was much overlap in the challenges relating to each sector
Small groups involving two country based teams in each case took each social
challenge and considered how it may change and develop given current
understandings of the forces affecting change (some forces may promote change
and some may block change) These were considered against potential political
developments economic developments socialsociological change technological
development legallegislative changes and environmental factors with a focus on
volume nature depth timeframe and scale of importance in influencing future
developments in social services
This work informed extensive discussion at the INNOSERV June 2012 Consortium
meeting with regard to the impact of key future developments on innovation and
the choice of projects which should be used to test key innovation developments
and their relevance to future service development
Relevance is represented in the INNOSERV criteria framework by the lsquodriversrsquo box
which includes a number of examples The most significant social challenges and
changes which were identified by the Consortium as most pertinent to innovation in
social services are listed in table 2 (page 19) and are explored further in the
remainder of this section The selection of projects as case studies has included
analysis of which of these social challenges and changes are being addressed (see
Work Package 4 report Eurich and Strifler 2012)
41 Demographic change as a key societal change driving innovation in the
health and welfare social service sectors
Demographic change was identified as a driving force of innovation in both health
and welfare services in Europe Current demographic change is resulting in
increased numbers of people living longer into old age with a particular increase in
the numbers of people aged over 80 This is alongside a reduction in the numbers
of people of working age in part due to a declining birth rate Further socio-cultural
change is leading to concerns about levels of informal care for older people
While many people will want to live active lives in old age some will live with long
periods of ill health and will have complex care needs resulting from multiple co-
morbidities Most however prefer to live as independently as possible
Questions arise about the ability to meet these increasing care demands from
declining tax income bases In addition the specific needs of elderly patients with
dementia represent a unique challenge for nursing staff and the organisation of
nursing services Financing of the rising health care costs for public agencies or for
health insurance schemes requires sustainable solutions and structural reforms
Traditional models of hospital lsquoacutersquo care may not necessarily be appropriate for
meeting these health care needs
This all highlights the need to find alternative solutions to care needs including the
use of technology and reliance on informal carers Current responses which are
relevant to this driver include integration of health and social care services to
increase cost efficiencies use of technological solutions to enhance self care and
care at home and new paradigms such as Active Ageing
19
Table 2 Key social challenges and changes driving innovation
Social
challengesocial
change driving
innovation
Meaning Social service sector
in which driver is key
Demographic
change
Increase in numbers of over 65s Greatest
increase in over 80 age group Increase in
old age dependency ratio
Health sector
Welfare sector
Aspirations Rising expectations of citizens for better
quality of lifebetter care
Health sector
Education sector
Cross sector services of
education and health
Lifestyles Increase in certain diseases related to
obesity alcohol and drug consumption
and stress diabetes liver disease anxiety
and depression
Health sector
Cross sector services of
education and health
Technology Access to information new media
technology
Health sector
Continued
inequalities
Continued economic inequality
unemployment continued poverty
including child poverty continued
institutionalisation continued inequality for
people with disabilities ethnic minorities
gender inequalities impact of socio-
economic status on health outcomes
Welfare sector
Education sector
Cross sector services of
education and health
and welfare and
education
Independent living The approach now adopted by disabled
people to live as ordinary members of
society and in their chosen domestic
setting
Welfare sector
Social roles Changing families increase in single
households increase in single parent
families changing generational relations
(due to longer life expectancy) reduction in
extended families
Changing gender roles rising female
employment rates
Welfare sector
Education sector
Organisational
changes
Creating new organisational forms
application of more responsive
management processes performance
management culture
Welfare sector
Changing
management
styles
Application of more responsive
management processes
Education sector
Cross sector services of
education and health
20
42 Aspirations as a key societal change driving innovation for health and
for education service sectors
Citizen aspirations were identified as a key societal change acting as a driving force
for innovation within both the health and education sectors and across the
boundary of these sectors Across Europe citizens are expecting a better quality of
life including improved outcomes from health and care services and reduced
inequalities
In terms of the health service sector this both derives from and manifests itself in
a population which is more informed about health issues Consequently patients
wish to be more involved in decisions about their health and their health care
options and are more willing and able to participate in the management of their
condition There is less deference to the medical profession and greater willingness
to make demands on health services There are a growing number of patient led
movements which are challenging some medical traditions
This aspect is fundamental both to everyday practice and to the future development
trajectory for health care services While most health aspirations are limited by
current knowledge and medical skill as research and medical advance offer new
choices and opportunities but at greater costs there will be difficult questions for
political debate This could well result in very different more personalised and
lsquopatient managedrsquo models of health care support
In terms of the education service sector individualism and the connected
aspiration of lsquobeing involvedrsquo has been an increasing trend over the past years and
is expected to keep gaining importance This is not only reflected by agendas of
individually shaped curricula or learning arrangements in school but also by the
opening of the public (ie government funded) school system towards involvement
of the community (seniors in school corporate sponsoring external initiatives of
informal learning and personality formation etc) This is reflected in a similar way
in higher education (eg service learning) and adult education (lsquolearning regionsrsquo)
Across the boundary of health and education aspirations coupled with medical
advance lead to a desire for independence of disabled people and those with long
term conditions This highlights the need for health programs focussed on self
esteem
43 Lifestyles as a key societal challenge driving innovation in the health
service sector and also in the cross sector services of health and education
A key social challenge acting as a driving force for innovation for the health sector
and in the cross sector services of education and health is a recognised growth in
lsquolifestylersquo related conditions arising from unhealthy behaviours such as poor diet
alcohol consumption and smoking (although there is limited evidence of a decline
in smoking rates as its harmful effects are less well tolerated) Political investment
in public health is recognised as an important strategic ambition but often not
matched by financial resources Questions about personal responsibility are also
being asked with suggestions that people with poor health behaviours should not
be given the same priority to responsive health care services As other factors
impacting on health outcomes become more responsive to medical advance these
factors are growing in importance in their impact both on wider society and in
improving overall health outcomes
21
44 Technology as a key societal change driving innovation in the health
service sector
The growth in internet and web based technology is leading to an exponential
growth in access to information and new forms of communication More people
now use the internet as their primary health care information resource Web
lsquocommunitiesrsquo are linking and thus empowering people faced with similar health
challenges Telehealthcare solutions to on-going care needs are becoming more
widely available and are changing the patterns of demands for some health care
services Other new technologies for example in transport and in home assistance
devices are enabling greater independence for disabled people
As future generations use and expect more from access to information and
communication services health care services will have to respond to both the
demands and the opportunities created by such technology Technology can be
seen as both a driving force for innovation and as an enabler of change
45 Continued inequalities as a key societal challenge driving innovation in
welfare and education service sectors also in cross sector services of
education and health and welfare and education
Continued inequalities were identified as a key driving force for innovation within
both welfare and education sectors and in services which straddle the boundary
between education and health services and education and welfare services
Inequalities stem from issues of migration social originbackground
unemployment disability and gender and have been a source of the social
upheaval which has been seen in Europe in recent months
Within health education the link between socio-economic status and health is clear
with people from lower socio-economic groups experiencing poorer health and less
likely engaging in health promoting behaviours In the case of migrants health
messages need to be delivered in a culturally appropriate manner
46 Independent living as a key societal change driving innovation in the
welfare service sector
In terms of disability the emergence and spread of the independent living
philosophy has been a key change driving innovation in the welfare service sector
Typically innovation in this field involves new stakeholder roles with a much more
proactive role for service users in all stages of service provision design
implementation monitoring and fine tuning of services as well as a role in
coordination of different entitlementsservices andor administration and reporting
requirements The boundaries are being pushed further deeper and wider every
day Starting from persons with physical disabilities services are now promoting
active involvement of persons with severe mental disabilities a development that
was deemed impossible only 30 years ago
47 Social roles as a key societal change driving innovation for welfare and
for education service sectors
Changing social roles were identified as a key challenge driving innovation within
the welfare and education sectors These changes are within families and of the
family itself and include changing gender roles and changing family structures (eg
increase in single parent families increase in the numbers of older people living
alone) Families seem to be becoming a sphere of public or community interest
rather than an exclusively private one
Proper lsquosocializationrsquo of children is the key to building viable and sustainable
futures for individuals Early stage family intervention is necessary to prevent the
22
very emergence of conflicts lsquoExternalrsquo interventions often do not reach every day
interaction and thus the root causes of problems This is of significance for family
based projects as well as for care institutions and education providers
48 Organisational changes as a key societal change driving innovation in
welfare service sectors
The shifting of provision of services from the public sector into other sectors such
as independent profit making companies and social enterprises creates new
opportunities for innovation In addition there is an increasing move to provide
services locally in order to be more relevant and responsive and a move to
community based models of care
49 Changing management styles as a key innovation challenge for the
education service sector and in cross sector services of the health and
education sector
Connected to individualism as well as new social roles of individuals family
community and institutions management styles shaped by multi-stakeholder
involvement are gaining importance Community based models do not only increase
the complexity of players involved in the lsquovalue creationrsquo process but also the
enhancement of skill development and personality formation as well as the
fertilization of the educational landscape by innovative ideas expertise and
practices of diverse partners The latter fact also stimulates an increase in cross-
sectoral services (education health and social services) Simultaneously this
situation increases the necessity to spot choose and foster the lsquoinfluencesrsquo and
lsquocombinationsrsquo which realize the highest value through the assessment of social
impact
Increased emphasis is also being placed on illustrating and monitoring
performance Impact measurement and associated tools and practices gain
overarching importance
In terms of changing management styles within the health and education sector an
important aspect is the cooperation of different stakeholders and the involvement
of the community or userrsquos perspective Linked to increased user aspirations
people would like to take part in the development of programs and services With
their special knowledge of their condition for example they can contribute their
expertise within social services
23
5 Other key challenges driving innovation
Sociatal challenges and changes are of course only one driving force of innovation
In addition to these there are other meso and micro level factors which also drive
innovation These include research and development leading to new knowledge
professionally led innovation in response to users needs increasing costs of service
provision and demands for greater efficiency per se and specific political contexts
These other forces are included in the INNOSERV criteria framework in the
lsquochallengesrsquo box These factors are not a key focus for selection of projects for
INNOSERV as they are often very situation specific but will be noted in the case
studies where relevant The factors which prompt or trigger specific innovations
whether socially based or otherwise are not are not mutually exclusive (Bason
2010) and in there is a complex and interacting relationship between a variety of
factors for any given innovation lsquoinstancersquo In addition there are well documented
factors which act to inhibit the development of innovative responses (see Crepaldi
et al 201215)
This work package has sought to identify generic criteria and drivers but it must be
recognised that the dynamics of individual settings and local factors will impact on
the actual processes of adoption
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
24
6 Conclusions and next steps
This report has presented the framework which has been used within the INNOSERV
project to support the choice of innovative case studies and to assist in identifying
the innovation phenomena potential and processes important to future research in
this area The framework has been used to select projects as case studies (see Work
Package 4 report Eurich and Strifler 2012) The framework interlinks aspects of
innovation (novelty type context improvement sustainability) with analysis of
challenges and changes which are acting as driving forces of innovation in social
services As the project is future facing it is proposed that key social challenges
and changes are likely to inform the development of new change paradigms for the
delivery of social services across Europe The framework will inform further
development and testing of concepts through the next stages of the INNOSERVE
programme This process will result in descriptions for the key areas in which future
research on innovation in social services should be taken forward
25
7 Bibliography
Bason C (2010) Leading public sector innovation Co-creating for a better society
Bristol The Policy Press
Bereiter C (2002) Design research for sustained innovation Cognitive Studies
Bulletin of the Japanese Cognitive Society 9 321-327
Christensen CM and Overdorf M (2000) Meeting the Challenge of Disruptive
Change Harvard Business Review March-April
Clark M and Goodwin N (2010) Sustaining innovation in telehealth and telecare
WSDNA briefing paper London The Kings Fund
Crepaldi C De Rosa E And Pesce F (2012) Literature review on innovation in
social services in Europe (sectors of Health Education and Welfare
Services)INNOSERV Work Package 1 report
Department of Health (2011) Innovation Health and Wealth Accelerating Adoption
and Diffusion in the NHS London Department of Health
Eurich J and Strifler A (2012) European compared selection of innovative social
services INNOSERV Work Package 4 report
Fuglsang L (2010) Bricolage and invisible innovation in public service innovation
Journal of Innovation Economics 5 67-87
Greenhalgh T Robert G Macfarlane F Bate P Kyriakidou O (2004) Diffusion of
innovations in service organizations systematic review and recommendations
Milbank Quarterly 82581-629
Hartley J (2005) Innovation in Governance and Public Services Past and Present
Public Money and Management 25127-34
Koch P and Hauknes J (2005) On innovation in the Public Sector Publin report no
D20
Kuhn T (1962) The Structure of Scientific Revolutions Chicago The University of
Chicago Press
Lakatos I and Musgrave A (eds) (1970) Criticism and the growth of knowledge
London Cambridge University Press
May
C Finch T Mair F et al ( 2007) Understanding the implementation of
complex interventions in health care the normalization process model BMC Health
Services Research 2007 7148 doi1011861472-6963-7-148
May et al (2009) Implementing Embedding and Integrating Practices An Outline of
Normalization Process Theory Sociology 43 535-554
Murray R Caulier-Grice J and Mulgan G (2010) The Open Book of Social
Innovation London The Young Foundation
26
OECD (2005) Oslo manual Guidelines for collecting and interpreting innovation
data 3rd
edition
Oliver M (1990) The politics of disablement Basingstoke Macmillan Education Ltd
Osborne S (1998) Naming the Beast Defining and Classifying Service Innovations
in Social Policy Human Relations 51 9 1133-1154
Osborne S and Brown K (2005) Managing Change and Innovation in Public Service
Organizations London Routledge
Phills JA Deiglmeier K and Miller DT (2008) Rediscovering Social Innovation
Stamford Innovation Review 6 4 34-43
Sullivan M (1987) Sociology and Social Welfare London Allen and Unwin
Tidd J and Bessant J (2009) Managing Innovation Integrating Technological
Market and organizational Change 4th
edition Chichester John Wiley and Sons
UK Government Department of Health (2011) Innovation Health and Wealth
Accelerating adoption and diffusion in the NHS London Department of Health
Wolfensburger W (1975) The principle of normalisation in human services Toronto
National Institute on Mental Retardation
27
8 Appendices
Appendix 1 Summary of types and criteria of innovation used in Work Package
3 to identify practices
Identification of social service
Field(s) of service
Logic(s) of service
Self help or mutual aid logic Social care logic Multi-stakeholders logic Social
movements logic Combination
Activities of services delivered
Assistance for persons faced with personal challenges or crises (debt unemployment
drug addiction other) (Re)integration of persons into society (rehabilitation language
training for immigrants other) Services to the labour market (occupational training)
Social housing for disadvantaged groups Care (for the elderly children families )
Treatment and support of people with physical illnesses Treatment and support of
people with mental health problems Combination
Status of the provider organization
Public organization (governmental) Private organization ndash nonnot for profit Private
organization ndash profit Volunteer association Cooperative company or mutual company
Familyneighbourhood Civil society network Combination Other
Target group
Children Youngsters Elder people Unemployed people Poor people Immigrants
Disabled people People with chronic diseases ndash long-term health problems People with
acute or short term health problems No specific target group (eg territory-based social
services provision aiming at strengthen social ties) Combination Other
Size of the organization
Innovation
Type of innovation
New forms of organization resources hybridization new targeted actions new services
non-structural practices other
Innovative character
do the service practices appear to be something new in the field of social services
Origins of innovation
Supply side demand side broader operating factors
Impact on service performance
Effectiveness of service delivery
from user perspective cost effectivenesscapacity building sustainability of
innovation
Quality of provision
28
Socialization quality of life as judged by users and beneficiaries more inclusion
lower risk on exclusion participation of the user transition from institutional to
community based care
Potential wider effects
Promoting social and health equality sustainability new skills and jobs
increased social rights affordability of adequate and high quality health and long-
term care promotion of equality and non-discrimination equal access to adequate
provision
Transferability of innovations between national contexts
29
Appendix 2 levels of innovation identified within INNOSERV Work Package 2
literature review
Organizational level (policy organizational sectors)
New social services designed to face new needs or unmet needs
Search for new solutions to old needs new mechanisms or practices introduced in
preexisting
social services
to improve access to social services (ie more information increased
professionalism in
social work sector)
to guarantee entitlements (rights) for specific groups or minorities
to satisfy the demand for social services in a more complete and broad way
(holistic
approach)
to guarantee more participation and inclusion of citizens
New and increased Cross-Sectoral social services
Cross-Sectoral social services (ie teaching art to children while helping their mothers
for
job seeking and offering jobs for young artists)
Integrated care practices
Tearing down walls between sectors and the role of informal care
Sharing of knowledge
Better integration of Health and Social sector services
Territory based social services that contribute to the creation of training and job
opportunities for disadvantaged people
Solidarity-based social services
Social mediation for impaired and weakened people
Easy access to housing for poor families
New interfaces with clients
Logic(s) of service Self help or mutual aid logic Social care logic Multi-stakeholders
logic
Social movements logic
The development of the self-help sector
Actors New organizations (Cooperative society for social service provision ndashSCOP
Cooperative society as social enterprise with userrsquos involvement ndashSCIC)
New legal forms within structured public frameworks (Italy social cooperatives)
New provider organizations and existing organisations refashioned by new dynamics
New roles and relations among actors
New private organizations for profit and non-profit
Management style in the organization
Regulatory and legislative level
New architecture of the provision system
Socially responsible public contracts and social clauses (outsourcing)
Adherence to EU standards in transitional economies
Impact on institutional framework that shape innovation in social services
New arrangement between one or more government agencies andor external
organization
Organizational level ndash Connection and Cooperation (governance and partnership)
New networks and social movements established in order to design deliver and
finance
social services
Cooperation between sectors actors and different forms of provision
Cooperation between local actors
Increasing communication responsiveness
30
Utilizing connectivity and interdependencies
Modification of organizational systems (models of governance work organisation
number
of involved stakeholders in governance)
Public sector and local authorities as promoters of innovation and promoters of
crosssectoral
policy strategies
Third sector and user as promoters of innovation
Volunteer workers and initiatives launched by a group of citizens
Third sector and userrsquos engagement design (co-design and re-design services)
Joint decision process
Decision-making power not based on capital ownership
Employee and user driven innovation
Partnerships with users family carers and user organizations
Partnership between service users practitioners and academics
Community-based and participative health network in a local territory
Collaboration between public and volunteer organisations (NGOs) or between civil and
local
networks in collaboration with public organisations and social enterprises
New techniques for partnership building and functioning
Impact on social and power relations
Professional level (practitioners)
New practices in social work
Innovative tools (ie Theatre of the Oppressed) and the use of participated methods in
social
work (ie self-help group)
Networking
Individualised supports
New professional skills in social work
The use of informatics and new technologies in social work
Users
Participation and involvement of final users of services in designing delivering and
evaluating social services
Involvement of final users in promoting equality effectiveness and control and
adherence
to the needs of users
Conceptual Level (and value)
New models of society - Social goals participation user involvement community
benefit
New paradigms underlying a new social service concept or service delivery model (ie
new
inclusion paradigm active ageing)
Relationships and trust
Pursuing diversity
Better adjustment to usersrsquo needs more person centred support
More social services provision in less developed regions
New concept of accessibility of the service (ie for Roma families)
The concept of lsquoprogressive universalismrsquo
The Social Care Model
De-institutionalization and community care Improved home-based and community
services
Gender and diversity perspectives
Anti-discrimination and equality process
Increase of the level of recognition of social values objectives paradigms and goals
New models of interaction leading to social innovation processes
31
Public policy level (policy framework programs and social policies)
The new role of the system governance played by central (or local depending on
national
arrangements) government
Impact on public policies new public policy programme measure or intervention
Joint construction of a space for public action and redefinition of public governance
bodies
and methods
Innovative logics for public policies
Innovating the public sector
The new wide attention on anti stigma policies
E-government
Financial and economic sustainability level (and scaling-diffusion-transferability
of innovation)
New ways to overcome budgetary constraints
New approaches to acquire funding
The involvement of private investors
The introduction of special funds
The purchase of innovative practices by final users
Hybridization of resources (market redistribution and reciprocity resources)
New investment sources
Mobilising community resources taking full advantage of all endogenous resources
Improvement in efficiency and effectiveness
Financial and systemic sustainability Impact on the economy
Economic Environmental and Social Sustainability of Territory based social services
Financial tools necessary to territorial social initiatives and the way to unlock them
Capacity of spreading and diffusion
Evaluative level and attention for quality
Affordability availability and accessibility
New standards expected
New feedback loops from users and specialists
Social services of excellence as for quality efficiency and efficacy
New methods and creative tool-kits to strengthen and renew the quality of social care
services
Low-cost (for user) and high level quality of social services
Quality assurance moderation and accreditation mechanisms
New tools for monitoring social services - hearing all voices (users organizations
practioners staff family and friends)
Action research
Alternative economic and social indicators
Social impact and contribution of innovation in social services to social innovation and
social change ndash Assessment of innovation
Learning approach to evaluation ndash lsquoto learn from failuresrsquo
Developmental evaluation
Specifics for the Health sector
Disability from rehabilitation to integration and then to inclusion
Mental Health from segregation to inclusion and community care
HIV from segregationstigmatization to awareness campaigns for promoting self
protection
Innovation in the area of prevention of treatment and in the introduction of new
technologies
Emphasis on an inter-sectoral controlled and steered care in managed care models
replacement of the traditional insurance model
Integrated services
Technological progress
32
Specifics for the Education sector
Inclusive education
Inclusive education and training in collaboration with the civil society
Multicultural education
Integration of disciplines
Alternative schools non-regular schools and informal education
Link between formal and informal education
Community development based approaches
Connection between regular school and the system of social services
Experiential learning
Human rights education
Working lsquothrough relationshipsrsquo with children and young people
Problem based learning methodology
The lsquomedia educationrsquo The use of comics
ICT in schools
E-inclusion
Networks of schools
Improve supplement reinvent and transform learning
Sustained educational improvement
Learning Beyond the Classroom
Spreading a culture that values learning
More personalized approaches to learning
Using the web
Learning with and by not to and from
33
Appendix 3 analysis of social challenges and changes driving innovation
Welfare
Societal
change as
driving force
of innovation
in social
services
Meaning
description
Related
outcomesother
factors
Examples of innovative
responses
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
Empowerment self-
determination choice
The lsquoassertive userrsquo
Demand for more
individualised services of
better quality
Alternativecomplementary
providers
Personalisation
Co-production (new
userprofessional
relationships)
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demand on services
Potential for poor access
to services (from
communication
problems social
isolation)
Multiculturalism
Integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Declining female
caregiving
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
34
Increased demand for
services demand for
formal care
Continued
inequality
Continued
economic
inequality
unemployment
continued poverty
including child
poverty continued
institutionalisation
continued
inequality for
people with
disabilities ethnic
minorities gender
inequalities
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients
with complex
comorbidities increase
in certain diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing demand for
services Increasing
costsneed to make
limited resources go
further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
Decisions about value
marketization
Technological
development
Access to
information new
media technology
Facilitates self
determination increases
expectations and choice
population better
informed about
conditionsservicesright
s and less deferential
Users better able to
35
mobilise
Increased exclusion of
some groups with limited
access
New models of remote
care provision
Ability to exchange
information on quality
and experience
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Increasing costs
Decisions about value
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Organisational
change changing
management
styles
philosophies
Creating new
organisational
forms application
of more responsive
management
processes
performance
management
culture
Integration of
organisationsfunctions
new approaches to
lsquocommissioningrsquo of
organisationsservices
distortions caused by
lsquolocked inrsquo expenditures
(tertiary health care
residential care)
Decentralisation
deinstitutionalisation
marketization liberalisation
The lsquoenabling
statersquo Political
will fiscal space
Impact of financial
crisis competing
priorities for public
funds
Legacy of category-based
(not needs based) social
protection structural
transition
deindustrialisation
Health
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
EmpowermentSelf-
determination choice
Demand for more
individualised services of
better quality
Users better able to mobilise
Assertive lsquouserrsquo
knowledgeable patient
Alternativecomplimentary
providers
36
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demands on
services
Potential for poor access
to services (from
communication
problems social
isolation)
MulticulturalismTrained
health professionals
move to richer countries
integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Declining female
caregiving
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
Increased demand for
formal care services
Continued
inequalities
Unequal
distribution of
health risks and
health
outcomediseases
by socioeconomic
indicators
Unequal access to
care by social
status geography
gender and
ethnicity
Demographic Increase in
numbers of over
Increase in patients with
complex comorbidities
Increasing demand for care
Decisions about value Active
37
change 65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing costsneed to
make limited resources
go further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
ageing paradigm
Technological
development
Access to
information new
media technology
Self determination
expectations choice
population better
informed about
conditionsservicesright
s and less deferential
Ability to exchange
information on quality
and experience
New models of care provision
(eg telehealth care) new
health management systems
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Changing
management
stylesphilosophi
es
Application of
more responsive
management
processes
Decentralisation
deinstitutionalisation
marketization liberalisation
Lifestyle changes Increase in certain
diseases related to
obesity alcohol
and drug
Increasing
costsdemands for care
38
consumption and
stress diabetes
liver disease
anxiety and
depression
Education
Aspirations Rising expectations
by citizens for
better quality of
life
Self determination
choice consumerism
Education outside of formal
setting
Assertive user
Lifelong learningeducation
Migration Historical (post
colonial) migration
pan-EU migration
refugees
New needs for education
eg language and culture
Inequalities social
fragmentation
Social Roles Changing family
structure increase
in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
changing gender
roles rising
female
employment rates
Need to reconcile work
and family life
Parentingfamily skills
for vulnerable
parentsfamilies
Socialization of children
ndash social and emotional
deficits for children in
some environments
Work with families and
communities
Continued
inequalities
Inequality in
educational
accessattainment
by socioeconomic
status gender
people with
disabilities ethnic
minorities
Culture of failure
Promise to deliver social
mobility and economic
improvement
(Leadbeater and Wond
2010 pp 5-20)
Inclusive and multicultural
education
Differential support for
children from
lsquodisadvantagedrsquo
backgrounds
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients with
complex comorbidities
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
New group of older
39
learners
Technological
advance
Access to
information new
media technology
making learning
available in new
ways
Self determination
expectations choice
lsquoAssertive userrsquo
Increased exclusion of
some groups with limited
access
Changing
management
styles
philosophies
Community based models
Globalization Need to provide
educationtraining
which is suited to
modern knowledge
based global
economies
This report for the InnoServ project (grant agreement nr 290542) is supported
under the Socio-economic and Humanities Programme of FP7
Chris Hawker
Faculty of Health Sciences University of Southampton Building 67 University Road Highfield Campus Southampton SO17 1BJ
Tel +44 (0)23 8059 7968
Email CHawkersotonacuk
3
8 Appendices 27
Appendix 1 Summary of types and criteria of innovation used in Work Package 3
to identify practiceshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip27
Appendix 2 levels of innovation identified within INNOSERV Work Package 2
literature reviewhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip29
Appendix 3 analysis of social challenges and changes driving innovationhelliphelliphellip33
4
Summary
This report identifies theoretical trends and criteria for innovative service
development practices in social services developed through the INNOSERV project
and based on
The Innoserv WP1 Report
A further review of the relevant literature
Inputs from consortium members particularly at a two day workshop held in
June 2012
The INNOSERV criteria framework is used to show key links between innovation
criteria and the pressures for change and development in social services to identify
future developmental trends and to link key aspects of innovation with current and
future challenges which are driving innovation and social change
Key issues relating to the trends are developed in the report These will be tested
through the selection of innovation case studies illustrating a range of practices
from across Europe to inform a Europe-wide consultation process with key
stakeholders to identify issues gaps demands and indications for further research
on innovation in social services in Europe
5
1 Background identifying and developing innovation trends and criteria
This report identifies theoretical trends and criteria for innovative service
development practices in social services developed by the INNOSERV project as part
of the second work package The trends and criteria have been formed into a
criteria framework to be used in later work packages to inform the choice of project
case studies The purpose of the INNOSERV work programme is to identify the
innovation phenomena potentials and processes important to future research
around innovation in social services
The report draws on the INNOSERV Work Package 1 literature review (Crepaldi et al
2012) which discusses concepts definitions criteria and the content of innovation
in social services plus the work undertaken to identify innovative social services in
Work Package 3 This report builds on that work in order to identify theoretical
trends and criteria for investigating and categorising innovative practices
11 Framework development
This framework and analysis have been developed through the following processes
1 The criteria development draws heavily on the work undertaken within the
INNOSERV Work Package 1 literature review which describes concepts
definitions criteria and content of innovation and on work for the process of
collection of innovative practices within Work Package 3 The latter work
which began in February 2012 developed initial types and criteria for
assessing innovation These are given in full in the report of that work
package and are shown in an abbreviated form in Appendix 1 of this report
2 Eleven partner organisations and a member of the advisory board took part
in a teleconference discussion concerning aspects of criteria development in
March 2012 This identified the key research questions for Work Package 2
as
a What changes in social political economic and technological
development are driving changes in social services (see point 22 in
WP2 description)
b What types of innovation developments are being used in responding
to these changes (see point 23 in WP2 description)
3 Further literature research was undertaken in order to identify specific issues
relating to current societal challenges which act as driving forces for social
service innovation and to place innovation in social services within a dynamic
theoretical context
4 The Consortium members took part in a scenario planning exercise to
assess societal challenges which are driving forces for innovation in social
services now and into the future The results of this exercise were discussed
at a Consortium meeting in June 2012
5 Work packages 3 and 4 were managed through a parallel process all of the
first four work packages influencing each other
6 Criteria for the analysis of innovation were agreed at the Consortium meeting
and the framework developed
7 The criteria were then used for the final selection of projects which is
reported in Work Package 4 (Eurich and Strifler 2012)
6
This report draws very much on the contribution of all the partners although
responsibility for writing it lies with the University of Southampton UK
The report begins with a brief review of the background theoretical concepts
relating to how innovation developments can be understood against knowledge and
practice development in social services It goes on to present the INNOSERV criteria
framework and to explore each of its components
2 Innovation service development and social change paradigm
development and service development
The assessment and understanding of innovation in social services takes place
within a number of organisational and cultural contexts
Our understanding of what is normal and what is new informed by
o Cultural assessments of what is safe and a reliance on lsquoconfirmedrsquo or
accepted knowledge
o The capacity to take risks and try out new ideas in practice or apply an
existing idea in a new situation creating new outcomes
The legal and political environments in which services are developed and
whether they promote adoption of new ideas and practices
In the area of social services these kinds of developments are embedded in a
number of sociologically derived factors including
Local social power structures
Economic capacity or constraint
Political ideologies
Professional ideologies and expertise
These variously integrate into a number of understood social lsquoparadigmsrsquo which
support or inhibit innovatory change Paradigms can support change by enabling
innovative developments to occur to improve the quality or functioning of social
systems within the prevailing paradigm These paradigms can also inhibit thinking
and action which might challenge the fundamental basis of the paradigm
A number of innovative developments can also accumulate in a system and which
collectively begin to challenge the basis for the paradigm itself These may support
the shift into a new social paradigm and inform influence and even radically alter
the way social systems work and develop
An example of this in practice is how the understanding and legal acceptance of
equality for people with disabilities particularly learning disabilities grew from a
number of innovative developments
lsquoNormalisationrsquo (Wolfensburger 1975) proposed that society should include
people with disabilities within the range of normal human existence
The de-institutionalisation of care which can for example be traced to
people with learning disabilities being supported to live in ordinary domestic
settings rather than specialist hospitals in British Columbia Canada
alongside other similar development in other settings
The lsquoindependent livingrsquo movement through which people with disabilities
argued that they should manage their social supports to meet their own
7
personal objectives rather than accept the standardised offerings of social
services organisations
The development of a lsquosocialrsquo rather than lsquomedicalrsquo model for how disability
should be described and understood
Each of these was an innovation some more challenging to the prevailing lsquocarersquo
paradigm than others During the last years of the 20th
century together they
accumulated to deliver a change in the fundamental paradigm informing most
European social systems so that what became an lsquoequalitiesrsquo based framework now
underlies the basis for these social systems (See for example Oliver 1990)
In practice of course these developments occurred simultaneously and in different
places The lsquoequalitiesrsquo arguments developed in the political domain at the same
time and informed and were informed by the practical innovations The
accumulation of the ideas to challenge legal frameworks and care systems occurred
in different ways in differing national contexts The pace of such changes taking
place in Eastern European countries now seeking to adopt these ideas in a single
often politically driven change illustrates an extreme form of lsquoinnovationrsquo adoption
This kind of development reflects processes of knowledge development identified
by Kuhn (1962) as lsquoscientific revolutionrsquo Kuhn noted that developments can occur
within what he calls lsquonormal sciencersquo until individual discoveries appear to challenge
the prevailing paradigm Some accommodations are often then made to the
paradigm but then once enough discoveries appear to challenge the basis of the
prevailing paradigm a new model has to be formed to accommodate the
discoveries lsquoNormalrsquo science can then resume within the new paradigm until this is
then in turn challenged The generation of a new paradigm also creates the
opportunity for new hypotheses which can be tested to form an expanded range of
ideas and knowledge These theories are complex and have developed a number of
critical channels for understanding how knowledge development is shaped or
limited For example some paradigm frameworks disable discovery by forcing a
rigid linguistically determined structure on knowledge development which disables
or actively prevents discovery (see for example Lakatos and Musgrave 1970)
This approach helps to understand how innovative developments in social services
relate to models of social change (see for example Sullivan 1987) Innovations can
occur within social systems but then accumulate to create or require a new social
model for social services The new social lsquomodelrsquo then generates a number of
innovations within the new framework so the equalities based social systems for
people with disabilities continue to generate for example new ideas in
employment for people with disabilities as a part of the lsquoindependent livingrsquo
concept
Innovation development therefore takes place in a dynamic environment Social
services innovations are informing social change and vice versa In order to identify
future innovation trends in social services it is important to understand how
changes in wider society will generate demands for and the development
space for innovation in social services
social services innovation will itself generate new opportunities for social
change
Using this kind of theoretical underpinning this report draws on the INNOSERV
innovation criteria developed in Work Package 1 and reviews the impact of key
societal changes to identify a set of relevant theoretical trends
8
3 Developing and defining innovation criteria
A review of the INNOSERV Work Packages 1 - 3 was undertaken at a meeting of
consortium members in June 2012 The INNOSERV Work Package 1 literature review
(Crepaldi et al 2012) identified a variety of definitions of innovation in services
service innovation and social innovation The literature review provided a first
working definition of innovation in social services shown in box 1 below and also
identified an extensive list of criteria for innovation which is included as appendix
2 This Work Package (2) contributes analysis of the key social challenges driving
innovation in social services Work Package 3 involved the collection of innovative
practice examples using some initial categorisation of innovation (see appendix 1)
BOX 1 INNOSERV first working definition of innovation in social services Innovation in social services can be defined as a type of social innovation process Innovation of social services is delivering services in another way as an answer to current and future challenges in society It mainly concerns (i) designing and implementing new social services to face new needs or unmet needs (ie types of services offered to face autism migrants with an irregular status violence against women) (ii) introducing new social services (or new mechanisms or practices) new interfaces with clients or new practices in social work in pre-existing social services Novelty improvements (effectiveness and efficiency) and sustainability are only first set of criteria to identify innovation in social services Values and the socio-cultural foundations of innovations in the social sphere should be considered Firstly in dealing with social services 1 respond lsquoto pressing social demands which are not addressed by the market and are directed to vulnerable groups in societyrsquo 2 address societal challenges at a level in which the boundary between social and economic blurs and societal challenges are directed towards society as a whole 3 generate systemic changes in changing attitudes and values strategies and policies organisational structures and processes delivery systems and services (Europe 2020 strategy Executive Summary EC) Social services innovations can be considered as ways to enhance processes and the outcome of social innovation Secondly situating social services within a social innovation framework means to focus on ways processes and mechanisms activated by social services that are able (a) to cope with more pressing social needs (b) to stimulate new solutions mobilizing peoples creativity and connecting people ideas and resources to a context of limited resources and rising costs (c) to be able to see social challenges also as opportunities (EC 2010 Murray Caulier-Grice Mulgan 2010) Crepaldi et al 2012 25-26
9
Following the review of these work packages the key elements of innovation for the
INNOSERV project were identified as
relevance to current and future societal challenges
type of innovation response
novelty
improvement
sustainability
context of innovation
These elements were incorporated into the INNOSERV criteria framework developed
to link these key innovation elements together The framework is shown in box 2
Box 2 The INNOSERV criteria framework linking aspects of innovation
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
10
The core of the framework focuses on the ways in which key innovations respond to
drivers and challenges It links distinct types of innovation criteria First there are
those criteria which together define innovation type of innovation or response
novelty and hallmarks of innovation including context improvement and
sustainability Linked to these are drivers or key societal challenges driving
change in social services and other challenges prompting innovation
The remaining sections of this report provide a rationale and explanation of each of
these five separate aspects that make up the framework along with definitions and
explanations of the individual elements within each to provide an analysis against
which the remaining developmental phases of the Innoserv programme can be
assessed
31 Innovation responses innovation in practice
The INNOSERV Work Package 1 literature review and collection of examples has
helped to explicate innovation operating at different lsquolevelsrsquo within service systems
The levels identified in the literature review are shown in summary form in Box 3
and are provided in full including examples in appendix 2
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
11
From this five types of response are detailed within the INNOSERV criteria
framework new service new form of delivery new form of governance new form of
resourcing and new way of evaluation The meaning of these five levels is provided
in table 1 and examples are given to illustrate this It should be noted that the
levels of response are not necessarily exclusive and a specific practice innovation
may fall into more than one category
Box 3 identified levels of innovation in social services
organizational level (ie organization of the provision of social services
type of service target group delivering logics)
regulatory and legislative level (lsquohow services are regulated organised
provided and financed the modalities of service provision the types of
relationships between external service providers and public authoritiesrsquo
EC 2006 p 8)
organizational level ndash connection and cooperation (partnership
networks governance)
professional level (social work methods and practices) -
users level
conceptual level and values
public policy level (policy framework programs and social policies)
financial and economic sustainability level (and scaling-diffusion-
transferability of innovation)
evaluative level and attention to quality (quality standards)
Crepaldi et al 2012 98-99
12
Table 1 Levels of response
Response Definition Example
New service New or improved
product of the scheme
or process
Personalised instead of
generic service
New form of delivery New or improved means
by which the outcome is
achieved
Self-help or social enterprise
instead of government agency
New form of
governance
New or improved way
the scheme or process is
managed and where it
draws authority from
Co-operative or user managed
instead of public service
New form of
resourcing
New or improved
financial human or
physical inputs to the
scheme or process
Grant-funded collectively
staffed organisation instead of
professionally managed
government agency
New way of
evaluation
New or improved
parameters by which
success is judged
User assessment of
effectiveness instead or
professional determined
criteria
It is important to note that innovation within a service is more challenging to define
and measure than innovation in the sense of a product (OECD 2005) while a
product is a tangible entity innovation within service provision can be a either a
product or a process and can occur at different levels of service provision and there
are a number of potential complexities which may inform the structure set out in
table 1
Phills et al (2008) for instance state that social innovation can be
ldquoa product production process or technology (much like innovation in
general) but it can also be a principle an idea a piece of legislation a social
movement an intervention or some combination of themrdquo (39)
In discussing public sector services Hartley (2005) emphasises that innovation is
ldquonot just a new idea but a new practicerdquo (27) and argues therefore that definitions
need to recognise practical impact For services this impact might be at one of
several levels
The organisation literature on innovation offers the initial distinction between
product and process innovation to which other types of innovation have been
added such as position and paradigm innovation (Tidd and Bessant 2009) For
social service oriented innovation further types are added
For example Hartley (2005) identifies the levels of product service process
position strategic governance and rhetorical innovations Hochgerner (2011) adds
social types of innovation to include roles relations norms and values
13
Osborne and Brown (2005) critique a number of typologies to classify innovation
from the management literature They point out that the dichotomy between
process and outcome makes them alternatives whereas an innovation and
particularly innovation in services can be both With services there is often not a
distinct separation between product and process with production delivery and
consumption of services often occurring simultaneously (OECD 2005)
32 Novelty
The next aspect is innovation is novelty In terms of novelty a three way
categorisation is proposed for INNOSERV new perspectives on old needs or
problems new practices for old needs or problems a new practice for a new need
The categorisation reflects the need for innovation to address both existing needs
and new needs Again there is much discussion in the literature about novelty in
relation to innovation Two points are addressed which can be summarised as
lsquowhat degreelevel of novelty equates to innovationrsquo and lsquonew to whomrsquo
The first distinction to be made is between different levels of innovation
ldquoThere are degrees of noveltyrunning from minor incremental
improvements right through to radical changes which transform the way we
think about and use them Sometimes these changes are common to a
particular sector or activity but sometimes they are so radical and far-
reaching that they change the basis of societyhelliprdquo (Tidd and Bessant 2009
27)
Tidd and Bessant usefully break down the incremental-radical continuum as lsquodoing
what we do betterrsquo lsquonew to the enterprisersquo and lsquonew to the worldrsquo (Tidd and
Bessant 2009 38)
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
14
While for some writers a change must be radical or pattern breaking in order to be
innovation it has been argued that within services innovation can be small
adjustments (Fuglsang 2010) Fuglsang in fact argues for a view of innovation in
public sector services as a process of building of skills and expanding routines (68)
The second part of the argument lsquonew to whomrsquo is whether innovation relates to
absolute first use A common to view of innovation is not just those elements
developed within an institution but also those adopted from others (for example
see OECD (2005) for business sector innovation Phills et al (2008) regarding social
innovation Hartley (2005) and Koch (2005) in relation to innovation in public
services) Phills et al (2008) for example state
ldquoAlthough innovations need not necessarily be original they must be new to
the user context or applicationrdquo (Phills et al 37)
Osborne and Brown (2005) purport that most studies consider newness as new to a
person organisation society or situation but not necessarily first use (2005 120)
The authors go on to argue that these are in fact different forms of innovation
differently termed as objective and subjective innovation (Kimberly 1981) or
intrinsic and extrinsic innovation (Downs and Mohr 1976)
Hartley (2005) expounds the dissemination and adaptation of innovation to other
contexts as particularly important for public sector services arguing that public
goals ldquocan be enhanced through collaborative arrangements to create share
transfer adapt and embed good practicerdquo (27) She terms this ldquorsquolateralrsquo innovationrdquo
(33) of good practice adoption and adaption
An example of this approach to defining innovation within social services is seen in
the UK Government policy document on innovation within the National Health
Service which states
ldquoinnovation is as much about applying an idea service or product in a new
context or in a new organisation as it is about creating something newrdquo
(Department of Health 2011 9)
15
33 Hallmarks of innovation
Within social service systems it is not sufficient to focus only on novelty as a
marker of innovation In addition the INNOSERV framework includes certain
hallmarks of innovation including assessment of context quality and sustainability
331 Contextual fit
Different innovative approaches need to fit within different service framework
contexts and need adaptation to those contexts Drawing further on the above
discussion of novelty INNOSERV employ this to mean new to a given (for example
national) context This will reflect the diversity of social service contexts within the
European Union Case studies will also consider transferability of an innovation
from one context to another
332 Improvement in quality
ldquoIn public servicesinnovation is justifiable only where it increases public
value in the quality efficiency or fitness for purpose of governance or
servicesrdquo (Hartley 2005 30)
It is commonly understood that innovation is about improvement as well as novelty
Hartley (2005) offers a model which sets out the possible relationships between
innovation and improvement These relationships are for organisations showing no
improvement and no innovation improvement but no innovation innovation but no
improvement innovation and improvement Important points to highlight from this
model relate to innovation but no improvement first that innovations may not
always lead to success and a level of failure is to be expected second that
innovation can lead to increased but undesired choice loss of performance due to
the process of learning and innovations that are ultimately of no value In terms of
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
16
what is to be measured as improvement Hartley maintains that beyond
improvements in service quality and fitness for purpose wider issues of public
value should be considered
The difficulties of measurement and evaluation of innovation in social services need
to be highlighted as the measures of success within a social project are difficult to
define (Bason 2010 Murray et al 2010) Improvement of social services can
include improved quality of life and access to economic and social opportunity
These issues may relate differently in the fields of health welfare and education
For instance quality of life within health may relate to physical health and mental
wellbeing at different stages of life within welfare issues such as equality of access
to housing cultural and community activities and employment are important
The INNOSERV case studies will include available information on the outcomes of
the innovative project although these will likely vary in terms of types of
measurement used by the projects
333 Sustainability
ldquoInnovation is not just about the originating idea but also the whole process
of the successful development implementation and spread of that idea into
widespread userdquo (Department of Health 2011)
It is recognised that change through innovation needs to be sustainable (Bereiter
2002) Achieving a sustainable innovation may involve streamlining of ideas and
altering them to work in everyday practice (Murray et al 2010 12) The
Normalisation Process Model offered by May and colleagues (May et al 2007 May
et al 2009) provides a theoretical explanation within the context of health care of
the processes through which interventions become embedded in practice and then
integrated and sustained
17
4 Drivers of innovation key societal changes
Innovation within social services needs to be relevant to key social challenges and
changes This relates to the purpose of social services in responding to pressing
social demands and societal needs It is therefore important for the INNOSERV
project to have an understanding of the key social challenges and changes driving
innovation to inform the lsquotheoretical trendsrsquo influencing future innovation
requirements As part of this work package we have therefore sought to identify
social challenges and changes which may act as driving forces of innovation and
shape the development of social service lsquoparadigmsrsquo and hence future social
change
Using a lsquoscenario planningrsquo methodology borrowed from management science can
help to test the limits to any paradigm and identify where new paradigm models
may be needed in the future This in turn should help to identify where future
research interests could be located to explore not just opportunities for innovation
within the current paradigm but also where socially driven change is creating new
opportunities (or indeed requirements) for social and social services innovation
Further these challenges feed into social service provision in terms of an imperative
to address new needs and level of need and issues of rising costs
The INNOSERV project undertook such a scenario planning process the outcomes
of which inform what follows here Using an extended literature study on future
social challenges in the European context a number of key factors promoting a
response from and requiring change in social services were identified Individual
partners made further analysis of the important social challenges within their own
national context The factors were synthesised into a table of key social challenges
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
18
(see appendix 3) separately for health welfare and education sectors although
there was much overlap in the challenges relating to each sector
Small groups involving two country based teams in each case took each social
challenge and considered how it may change and develop given current
understandings of the forces affecting change (some forces may promote change
and some may block change) These were considered against potential political
developments economic developments socialsociological change technological
development legallegislative changes and environmental factors with a focus on
volume nature depth timeframe and scale of importance in influencing future
developments in social services
This work informed extensive discussion at the INNOSERV June 2012 Consortium
meeting with regard to the impact of key future developments on innovation and
the choice of projects which should be used to test key innovation developments
and their relevance to future service development
Relevance is represented in the INNOSERV criteria framework by the lsquodriversrsquo box
which includes a number of examples The most significant social challenges and
changes which were identified by the Consortium as most pertinent to innovation in
social services are listed in table 2 (page 19) and are explored further in the
remainder of this section The selection of projects as case studies has included
analysis of which of these social challenges and changes are being addressed (see
Work Package 4 report Eurich and Strifler 2012)
41 Demographic change as a key societal change driving innovation in the
health and welfare social service sectors
Demographic change was identified as a driving force of innovation in both health
and welfare services in Europe Current demographic change is resulting in
increased numbers of people living longer into old age with a particular increase in
the numbers of people aged over 80 This is alongside a reduction in the numbers
of people of working age in part due to a declining birth rate Further socio-cultural
change is leading to concerns about levels of informal care for older people
While many people will want to live active lives in old age some will live with long
periods of ill health and will have complex care needs resulting from multiple co-
morbidities Most however prefer to live as independently as possible
Questions arise about the ability to meet these increasing care demands from
declining tax income bases In addition the specific needs of elderly patients with
dementia represent a unique challenge for nursing staff and the organisation of
nursing services Financing of the rising health care costs for public agencies or for
health insurance schemes requires sustainable solutions and structural reforms
Traditional models of hospital lsquoacutersquo care may not necessarily be appropriate for
meeting these health care needs
This all highlights the need to find alternative solutions to care needs including the
use of technology and reliance on informal carers Current responses which are
relevant to this driver include integration of health and social care services to
increase cost efficiencies use of technological solutions to enhance self care and
care at home and new paradigms such as Active Ageing
19
Table 2 Key social challenges and changes driving innovation
Social
challengesocial
change driving
innovation
Meaning Social service sector
in which driver is key
Demographic
change
Increase in numbers of over 65s Greatest
increase in over 80 age group Increase in
old age dependency ratio
Health sector
Welfare sector
Aspirations Rising expectations of citizens for better
quality of lifebetter care
Health sector
Education sector
Cross sector services of
education and health
Lifestyles Increase in certain diseases related to
obesity alcohol and drug consumption
and stress diabetes liver disease anxiety
and depression
Health sector
Cross sector services of
education and health
Technology Access to information new media
technology
Health sector
Continued
inequalities
Continued economic inequality
unemployment continued poverty
including child poverty continued
institutionalisation continued inequality for
people with disabilities ethnic minorities
gender inequalities impact of socio-
economic status on health outcomes
Welfare sector
Education sector
Cross sector services of
education and health
and welfare and
education
Independent living The approach now adopted by disabled
people to live as ordinary members of
society and in their chosen domestic
setting
Welfare sector
Social roles Changing families increase in single
households increase in single parent
families changing generational relations
(due to longer life expectancy) reduction in
extended families
Changing gender roles rising female
employment rates
Welfare sector
Education sector
Organisational
changes
Creating new organisational forms
application of more responsive
management processes performance
management culture
Welfare sector
Changing
management
styles
Application of more responsive
management processes
Education sector
Cross sector services of
education and health
20
42 Aspirations as a key societal change driving innovation for health and
for education service sectors
Citizen aspirations were identified as a key societal change acting as a driving force
for innovation within both the health and education sectors and across the
boundary of these sectors Across Europe citizens are expecting a better quality of
life including improved outcomes from health and care services and reduced
inequalities
In terms of the health service sector this both derives from and manifests itself in
a population which is more informed about health issues Consequently patients
wish to be more involved in decisions about their health and their health care
options and are more willing and able to participate in the management of their
condition There is less deference to the medical profession and greater willingness
to make demands on health services There are a growing number of patient led
movements which are challenging some medical traditions
This aspect is fundamental both to everyday practice and to the future development
trajectory for health care services While most health aspirations are limited by
current knowledge and medical skill as research and medical advance offer new
choices and opportunities but at greater costs there will be difficult questions for
political debate This could well result in very different more personalised and
lsquopatient managedrsquo models of health care support
In terms of the education service sector individualism and the connected
aspiration of lsquobeing involvedrsquo has been an increasing trend over the past years and
is expected to keep gaining importance This is not only reflected by agendas of
individually shaped curricula or learning arrangements in school but also by the
opening of the public (ie government funded) school system towards involvement
of the community (seniors in school corporate sponsoring external initiatives of
informal learning and personality formation etc) This is reflected in a similar way
in higher education (eg service learning) and adult education (lsquolearning regionsrsquo)
Across the boundary of health and education aspirations coupled with medical
advance lead to a desire for independence of disabled people and those with long
term conditions This highlights the need for health programs focussed on self
esteem
43 Lifestyles as a key societal challenge driving innovation in the health
service sector and also in the cross sector services of health and education
A key social challenge acting as a driving force for innovation for the health sector
and in the cross sector services of education and health is a recognised growth in
lsquolifestylersquo related conditions arising from unhealthy behaviours such as poor diet
alcohol consumption and smoking (although there is limited evidence of a decline
in smoking rates as its harmful effects are less well tolerated) Political investment
in public health is recognised as an important strategic ambition but often not
matched by financial resources Questions about personal responsibility are also
being asked with suggestions that people with poor health behaviours should not
be given the same priority to responsive health care services As other factors
impacting on health outcomes become more responsive to medical advance these
factors are growing in importance in their impact both on wider society and in
improving overall health outcomes
21
44 Technology as a key societal change driving innovation in the health
service sector
The growth in internet and web based technology is leading to an exponential
growth in access to information and new forms of communication More people
now use the internet as their primary health care information resource Web
lsquocommunitiesrsquo are linking and thus empowering people faced with similar health
challenges Telehealthcare solutions to on-going care needs are becoming more
widely available and are changing the patterns of demands for some health care
services Other new technologies for example in transport and in home assistance
devices are enabling greater independence for disabled people
As future generations use and expect more from access to information and
communication services health care services will have to respond to both the
demands and the opportunities created by such technology Technology can be
seen as both a driving force for innovation and as an enabler of change
45 Continued inequalities as a key societal challenge driving innovation in
welfare and education service sectors also in cross sector services of
education and health and welfare and education
Continued inequalities were identified as a key driving force for innovation within
both welfare and education sectors and in services which straddle the boundary
between education and health services and education and welfare services
Inequalities stem from issues of migration social originbackground
unemployment disability and gender and have been a source of the social
upheaval which has been seen in Europe in recent months
Within health education the link between socio-economic status and health is clear
with people from lower socio-economic groups experiencing poorer health and less
likely engaging in health promoting behaviours In the case of migrants health
messages need to be delivered in a culturally appropriate manner
46 Independent living as a key societal change driving innovation in the
welfare service sector
In terms of disability the emergence and spread of the independent living
philosophy has been a key change driving innovation in the welfare service sector
Typically innovation in this field involves new stakeholder roles with a much more
proactive role for service users in all stages of service provision design
implementation monitoring and fine tuning of services as well as a role in
coordination of different entitlementsservices andor administration and reporting
requirements The boundaries are being pushed further deeper and wider every
day Starting from persons with physical disabilities services are now promoting
active involvement of persons with severe mental disabilities a development that
was deemed impossible only 30 years ago
47 Social roles as a key societal change driving innovation for welfare and
for education service sectors
Changing social roles were identified as a key challenge driving innovation within
the welfare and education sectors These changes are within families and of the
family itself and include changing gender roles and changing family structures (eg
increase in single parent families increase in the numbers of older people living
alone) Families seem to be becoming a sphere of public or community interest
rather than an exclusively private one
Proper lsquosocializationrsquo of children is the key to building viable and sustainable
futures for individuals Early stage family intervention is necessary to prevent the
22
very emergence of conflicts lsquoExternalrsquo interventions often do not reach every day
interaction and thus the root causes of problems This is of significance for family
based projects as well as for care institutions and education providers
48 Organisational changes as a key societal change driving innovation in
welfare service sectors
The shifting of provision of services from the public sector into other sectors such
as independent profit making companies and social enterprises creates new
opportunities for innovation In addition there is an increasing move to provide
services locally in order to be more relevant and responsive and a move to
community based models of care
49 Changing management styles as a key innovation challenge for the
education service sector and in cross sector services of the health and
education sector
Connected to individualism as well as new social roles of individuals family
community and institutions management styles shaped by multi-stakeholder
involvement are gaining importance Community based models do not only increase
the complexity of players involved in the lsquovalue creationrsquo process but also the
enhancement of skill development and personality formation as well as the
fertilization of the educational landscape by innovative ideas expertise and
practices of diverse partners The latter fact also stimulates an increase in cross-
sectoral services (education health and social services) Simultaneously this
situation increases the necessity to spot choose and foster the lsquoinfluencesrsquo and
lsquocombinationsrsquo which realize the highest value through the assessment of social
impact
Increased emphasis is also being placed on illustrating and monitoring
performance Impact measurement and associated tools and practices gain
overarching importance
In terms of changing management styles within the health and education sector an
important aspect is the cooperation of different stakeholders and the involvement
of the community or userrsquos perspective Linked to increased user aspirations
people would like to take part in the development of programs and services With
their special knowledge of their condition for example they can contribute their
expertise within social services
23
5 Other key challenges driving innovation
Sociatal challenges and changes are of course only one driving force of innovation
In addition to these there are other meso and micro level factors which also drive
innovation These include research and development leading to new knowledge
professionally led innovation in response to users needs increasing costs of service
provision and demands for greater efficiency per se and specific political contexts
These other forces are included in the INNOSERV criteria framework in the
lsquochallengesrsquo box These factors are not a key focus for selection of projects for
INNOSERV as they are often very situation specific but will be noted in the case
studies where relevant The factors which prompt or trigger specific innovations
whether socially based or otherwise are not are not mutually exclusive (Bason
2010) and in there is a complex and interacting relationship between a variety of
factors for any given innovation lsquoinstancersquo In addition there are well documented
factors which act to inhibit the development of innovative responses (see Crepaldi
et al 201215)
This work package has sought to identify generic criteria and drivers but it must be
recognised that the dynamics of individual settings and local factors will impact on
the actual processes of adoption
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
24
6 Conclusions and next steps
This report has presented the framework which has been used within the INNOSERV
project to support the choice of innovative case studies and to assist in identifying
the innovation phenomena potential and processes important to future research in
this area The framework has been used to select projects as case studies (see Work
Package 4 report Eurich and Strifler 2012) The framework interlinks aspects of
innovation (novelty type context improvement sustainability) with analysis of
challenges and changes which are acting as driving forces of innovation in social
services As the project is future facing it is proposed that key social challenges
and changes are likely to inform the development of new change paradigms for the
delivery of social services across Europe The framework will inform further
development and testing of concepts through the next stages of the INNOSERVE
programme This process will result in descriptions for the key areas in which future
research on innovation in social services should be taken forward
25
7 Bibliography
Bason C (2010) Leading public sector innovation Co-creating for a better society
Bristol The Policy Press
Bereiter C (2002) Design research for sustained innovation Cognitive Studies
Bulletin of the Japanese Cognitive Society 9 321-327
Christensen CM and Overdorf M (2000) Meeting the Challenge of Disruptive
Change Harvard Business Review March-April
Clark M and Goodwin N (2010) Sustaining innovation in telehealth and telecare
WSDNA briefing paper London The Kings Fund
Crepaldi C De Rosa E And Pesce F (2012) Literature review on innovation in
social services in Europe (sectors of Health Education and Welfare
Services)INNOSERV Work Package 1 report
Department of Health (2011) Innovation Health and Wealth Accelerating Adoption
and Diffusion in the NHS London Department of Health
Eurich J and Strifler A (2012) European compared selection of innovative social
services INNOSERV Work Package 4 report
Fuglsang L (2010) Bricolage and invisible innovation in public service innovation
Journal of Innovation Economics 5 67-87
Greenhalgh T Robert G Macfarlane F Bate P Kyriakidou O (2004) Diffusion of
innovations in service organizations systematic review and recommendations
Milbank Quarterly 82581-629
Hartley J (2005) Innovation in Governance and Public Services Past and Present
Public Money and Management 25127-34
Koch P and Hauknes J (2005) On innovation in the Public Sector Publin report no
D20
Kuhn T (1962) The Structure of Scientific Revolutions Chicago The University of
Chicago Press
Lakatos I and Musgrave A (eds) (1970) Criticism and the growth of knowledge
London Cambridge University Press
May
C Finch T Mair F et al ( 2007) Understanding the implementation of
complex interventions in health care the normalization process model BMC Health
Services Research 2007 7148 doi1011861472-6963-7-148
May et al (2009) Implementing Embedding and Integrating Practices An Outline of
Normalization Process Theory Sociology 43 535-554
Murray R Caulier-Grice J and Mulgan G (2010) The Open Book of Social
Innovation London The Young Foundation
26
OECD (2005) Oslo manual Guidelines for collecting and interpreting innovation
data 3rd
edition
Oliver M (1990) The politics of disablement Basingstoke Macmillan Education Ltd
Osborne S (1998) Naming the Beast Defining and Classifying Service Innovations
in Social Policy Human Relations 51 9 1133-1154
Osborne S and Brown K (2005) Managing Change and Innovation in Public Service
Organizations London Routledge
Phills JA Deiglmeier K and Miller DT (2008) Rediscovering Social Innovation
Stamford Innovation Review 6 4 34-43
Sullivan M (1987) Sociology and Social Welfare London Allen and Unwin
Tidd J and Bessant J (2009) Managing Innovation Integrating Technological
Market and organizational Change 4th
edition Chichester John Wiley and Sons
UK Government Department of Health (2011) Innovation Health and Wealth
Accelerating adoption and diffusion in the NHS London Department of Health
Wolfensburger W (1975) The principle of normalisation in human services Toronto
National Institute on Mental Retardation
27
8 Appendices
Appendix 1 Summary of types and criteria of innovation used in Work Package
3 to identify practices
Identification of social service
Field(s) of service
Logic(s) of service
Self help or mutual aid logic Social care logic Multi-stakeholders logic Social
movements logic Combination
Activities of services delivered
Assistance for persons faced with personal challenges or crises (debt unemployment
drug addiction other) (Re)integration of persons into society (rehabilitation language
training for immigrants other) Services to the labour market (occupational training)
Social housing for disadvantaged groups Care (for the elderly children families )
Treatment and support of people with physical illnesses Treatment and support of
people with mental health problems Combination
Status of the provider organization
Public organization (governmental) Private organization ndash nonnot for profit Private
organization ndash profit Volunteer association Cooperative company or mutual company
Familyneighbourhood Civil society network Combination Other
Target group
Children Youngsters Elder people Unemployed people Poor people Immigrants
Disabled people People with chronic diseases ndash long-term health problems People with
acute or short term health problems No specific target group (eg territory-based social
services provision aiming at strengthen social ties) Combination Other
Size of the organization
Innovation
Type of innovation
New forms of organization resources hybridization new targeted actions new services
non-structural practices other
Innovative character
do the service practices appear to be something new in the field of social services
Origins of innovation
Supply side demand side broader operating factors
Impact on service performance
Effectiveness of service delivery
from user perspective cost effectivenesscapacity building sustainability of
innovation
Quality of provision
28
Socialization quality of life as judged by users and beneficiaries more inclusion
lower risk on exclusion participation of the user transition from institutional to
community based care
Potential wider effects
Promoting social and health equality sustainability new skills and jobs
increased social rights affordability of adequate and high quality health and long-
term care promotion of equality and non-discrimination equal access to adequate
provision
Transferability of innovations between national contexts
29
Appendix 2 levels of innovation identified within INNOSERV Work Package 2
literature review
Organizational level (policy organizational sectors)
New social services designed to face new needs or unmet needs
Search for new solutions to old needs new mechanisms or practices introduced in
preexisting
social services
to improve access to social services (ie more information increased
professionalism in
social work sector)
to guarantee entitlements (rights) for specific groups or minorities
to satisfy the demand for social services in a more complete and broad way
(holistic
approach)
to guarantee more participation and inclusion of citizens
New and increased Cross-Sectoral social services
Cross-Sectoral social services (ie teaching art to children while helping their mothers
for
job seeking and offering jobs for young artists)
Integrated care practices
Tearing down walls between sectors and the role of informal care
Sharing of knowledge
Better integration of Health and Social sector services
Territory based social services that contribute to the creation of training and job
opportunities for disadvantaged people
Solidarity-based social services
Social mediation for impaired and weakened people
Easy access to housing for poor families
New interfaces with clients
Logic(s) of service Self help or mutual aid logic Social care logic Multi-stakeholders
logic
Social movements logic
The development of the self-help sector
Actors New organizations (Cooperative society for social service provision ndashSCOP
Cooperative society as social enterprise with userrsquos involvement ndashSCIC)
New legal forms within structured public frameworks (Italy social cooperatives)
New provider organizations and existing organisations refashioned by new dynamics
New roles and relations among actors
New private organizations for profit and non-profit
Management style in the organization
Regulatory and legislative level
New architecture of the provision system
Socially responsible public contracts and social clauses (outsourcing)
Adherence to EU standards in transitional economies
Impact on institutional framework that shape innovation in social services
New arrangement between one or more government agencies andor external
organization
Organizational level ndash Connection and Cooperation (governance and partnership)
New networks and social movements established in order to design deliver and
finance
social services
Cooperation between sectors actors and different forms of provision
Cooperation between local actors
Increasing communication responsiveness
30
Utilizing connectivity and interdependencies
Modification of organizational systems (models of governance work organisation
number
of involved stakeholders in governance)
Public sector and local authorities as promoters of innovation and promoters of
crosssectoral
policy strategies
Third sector and user as promoters of innovation
Volunteer workers and initiatives launched by a group of citizens
Third sector and userrsquos engagement design (co-design and re-design services)
Joint decision process
Decision-making power not based on capital ownership
Employee and user driven innovation
Partnerships with users family carers and user organizations
Partnership between service users practitioners and academics
Community-based and participative health network in a local territory
Collaboration between public and volunteer organisations (NGOs) or between civil and
local
networks in collaboration with public organisations and social enterprises
New techniques for partnership building and functioning
Impact on social and power relations
Professional level (practitioners)
New practices in social work
Innovative tools (ie Theatre of the Oppressed) and the use of participated methods in
social
work (ie self-help group)
Networking
Individualised supports
New professional skills in social work
The use of informatics and new technologies in social work
Users
Participation and involvement of final users of services in designing delivering and
evaluating social services
Involvement of final users in promoting equality effectiveness and control and
adherence
to the needs of users
Conceptual Level (and value)
New models of society - Social goals participation user involvement community
benefit
New paradigms underlying a new social service concept or service delivery model (ie
new
inclusion paradigm active ageing)
Relationships and trust
Pursuing diversity
Better adjustment to usersrsquo needs more person centred support
More social services provision in less developed regions
New concept of accessibility of the service (ie for Roma families)
The concept of lsquoprogressive universalismrsquo
The Social Care Model
De-institutionalization and community care Improved home-based and community
services
Gender and diversity perspectives
Anti-discrimination and equality process
Increase of the level of recognition of social values objectives paradigms and goals
New models of interaction leading to social innovation processes
31
Public policy level (policy framework programs and social policies)
The new role of the system governance played by central (or local depending on
national
arrangements) government
Impact on public policies new public policy programme measure or intervention
Joint construction of a space for public action and redefinition of public governance
bodies
and methods
Innovative logics for public policies
Innovating the public sector
The new wide attention on anti stigma policies
E-government
Financial and economic sustainability level (and scaling-diffusion-transferability
of innovation)
New ways to overcome budgetary constraints
New approaches to acquire funding
The involvement of private investors
The introduction of special funds
The purchase of innovative practices by final users
Hybridization of resources (market redistribution and reciprocity resources)
New investment sources
Mobilising community resources taking full advantage of all endogenous resources
Improvement in efficiency and effectiveness
Financial and systemic sustainability Impact on the economy
Economic Environmental and Social Sustainability of Territory based social services
Financial tools necessary to territorial social initiatives and the way to unlock them
Capacity of spreading and diffusion
Evaluative level and attention for quality
Affordability availability and accessibility
New standards expected
New feedback loops from users and specialists
Social services of excellence as for quality efficiency and efficacy
New methods and creative tool-kits to strengthen and renew the quality of social care
services
Low-cost (for user) and high level quality of social services
Quality assurance moderation and accreditation mechanisms
New tools for monitoring social services - hearing all voices (users organizations
practioners staff family and friends)
Action research
Alternative economic and social indicators
Social impact and contribution of innovation in social services to social innovation and
social change ndash Assessment of innovation
Learning approach to evaluation ndash lsquoto learn from failuresrsquo
Developmental evaluation
Specifics for the Health sector
Disability from rehabilitation to integration and then to inclusion
Mental Health from segregation to inclusion and community care
HIV from segregationstigmatization to awareness campaigns for promoting self
protection
Innovation in the area of prevention of treatment and in the introduction of new
technologies
Emphasis on an inter-sectoral controlled and steered care in managed care models
replacement of the traditional insurance model
Integrated services
Technological progress
32
Specifics for the Education sector
Inclusive education
Inclusive education and training in collaboration with the civil society
Multicultural education
Integration of disciplines
Alternative schools non-regular schools and informal education
Link between formal and informal education
Community development based approaches
Connection between regular school and the system of social services
Experiential learning
Human rights education
Working lsquothrough relationshipsrsquo with children and young people
Problem based learning methodology
The lsquomedia educationrsquo The use of comics
ICT in schools
E-inclusion
Networks of schools
Improve supplement reinvent and transform learning
Sustained educational improvement
Learning Beyond the Classroom
Spreading a culture that values learning
More personalized approaches to learning
Using the web
Learning with and by not to and from
33
Appendix 3 analysis of social challenges and changes driving innovation
Welfare
Societal
change as
driving force
of innovation
in social
services
Meaning
description
Related
outcomesother
factors
Examples of innovative
responses
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
Empowerment self-
determination choice
The lsquoassertive userrsquo
Demand for more
individualised services of
better quality
Alternativecomplementary
providers
Personalisation
Co-production (new
userprofessional
relationships)
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demand on services
Potential for poor access
to services (from
communication
problems social
isolation)
Multiculturalism
Integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Declining female
caregiving
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
34
Increased demand for
services demand for
formal care
Continued
inequality
Continued
economic
inequality
unemployment
continued poverty
including child
poverty continued
institutionalisation
continued
inequality for
people with
disabilities ethnic
minorities gender
inequalities
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients
with complex
comorbidities increase
in certain diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing demand for
services Increasing
costsneed to make
limited resources go
further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
Decisions about value
marketization
Technological
development
Access to
information new
media technology
Facilitates self
determination increases
expectations and choice
population better
informed about
conditionsservicesright
s and less deferential
Users better able to
35
mobilise
Increased exclusion of
some groups with limited
access
New models of remote
care provision
Ability to exchange
information on quality
and experience
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Increasing costs
Decisions about value
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Organisational
change changing
management
styles
philosophies
Creating new
organisational
forms application
of more responsive
management
processes
performance
management
culture
Integration of
organisationsfunctions
new approaches to
lsquocommissioningrsquo of
organisationsservices
distortions caused by
lsquolocked inrsquo expenditures
(tertiary health care
residential care)
Decentralisation
deinstitutionalisation
marketization liberalisation
The lsquoenabling
statersquo Political
will fiscal space
Impact of financial
crisis competing
priorities for public
funds
Legacy of category-based
(not needs based) social
protection structural
transition
deindustrialisation
Health
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
EmpowermentSelf-
determination choice
Demand for more
individualised services of
better quality
Users better able to mobilise
Assertive lsquouserrsquo
knowledgeable patient
Alternativecomplimentary
providers
36
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demands on
services
Potential for poor access
to services (from
communication
problems social
isolation)
MulticulturalismTrained
health professionals
move to richer countries
integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Declining female
caregiving
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
Increased demand for
formal care services
Continued
inequalities
Unequal
distribution of
health risks and
health
outcomediseases
by socioeconomic
indicators
Unequal access to
care by social
status geography
gender and
ethnicity
Demographic Increase in
numbers of over
Increase in patients with
complex comorbidities
Increasing demand for care
Decisions about value Active
37
change 65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing costsneed to
make limited resources
go further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
ageing paradigm
Technological
development
Access to
information new
media technology
Self determination
expectations choice
population better
informed about
conditionsservicesright
s and less deferential
Ability to exchange
information on quality
and experience
New models of care provision
(eg telehealth care) new
health management systems
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Changing
management
stylesphilosophi
es
Application of
more responsive
management
processes
Decentralisation
deinstitutionalisation
marketization liberalisation
Lifestyle changes Increase in certain
diseases related to
obesity alcohol
and drug
Increasing
costsdemands for care
38
consumption and
stress diabetes
liver disease
anxiety and
depression
Education
Aspirations Rising expectations
by citizens for
better quality of
life
Self determination
choice consumerism
Education outside of formal
setting
Assertive user
Lifelong learningeducation
Migration Historical (post
colonial) migration
pan-EU migration
refugees
New needs for education
eg language and culture
Inequalities social
fragmentation
Social Roles Changing family
structure increase
in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
changing gender
roles rising
female
employment rates
Need to reconcile work
and family life
Parentingfamily skills
for vulnerable
parentsfamilies
Socialization of children
ndash social and emotional
deficits for children in
some environments
Work with families and
communities
Continued
inequalities
Inequality in
educational
accessattainment
by socioeconomic
status gender
people with
disabilities ethnic
minorities
Culture of failure
Promise to deliver social
mobility and economic
improvement
(Leadbeater and Wond
2010 pp 5-20)
Inclusive and multicultural
education
Differential support for
children from
lsquodisadvantagedrsquo
backgrounds
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients with
complex comorbidities
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
New group of older
39
learners
Technological
advance
Access to
information new
media technology
making learning
available in new
ways
Self determination
expectations choice
lsquoAssertive userrsquo
Increased exclusion of
some groups with limited
access
Changing
management
styles
philosophies
Community based models
Globalization Need to provide
educationtraining
which is suited to
modern knowledge
based global
economies
This report for the InnoServ project (grant agreement nr 290542) is supported
under the Socio-economic and Humanities Programme of FP7
Chris Hawker
Faculty of Health Sciences University of Southampton Building 67 University Road Highfield Campus Southampton SO17 1BJ
Tel +44 (0)23 8059 7968
Email CHawkersotonacuk
4
Summary
This report identifies theoretical trends and criteria for innovative service
development practices in social services developed through the INNOSERV project
and based on
The Innoserv WP1 Report
A further review of the relevant literature
Inputs from consortium members particularly at a two day workshop held in
June 2012
The INNOSERV criteria framework is used to show key links between innovation
criteria and the pressures for change and development in social services to identify
future developmental trends and to link key aspects of innovation with current and
future challenges which are driving innovation and social change
Key issues relating to the trends are developed in the report These will be tested
through the selection of innovation case studies illustrating a range of practices
from across Europe to inform a Europe-wide consultation process with key
stakeholders to identify issues gaps demands and indications for further research
on innovation in social services in Europe
5
1 Background identifying and developing innovation trends and criteria
This report identifies theoretical trends and criteria for innovative service
development practices in social services developed by the INNOSERV project as part
of the second work package The trends and criteria have been formed into a
criteria framework to be used in later work packages to inform the choice of project
case studies The purpose of the INNOSERV work programme is to identify the
innovation phenomena potentials and processes important to future research
around innovation in social services
The report draws on the INNOSERV Work Package 1 literature review (Crepaldi et al
2012) which discusses concepts definitions criteria and the content of innovation
in social services plus the work undertaken to identify innovative social services in
Work Package 3 This report builds on that work in order to identify theoretical
trends and criteria for investigating and categorising innovative practices
11 Framework development
This framework and analysis have been developed through the following processes
1 The criteria development draws heavily on the work undertaken within the
INNOSERV Work Package 1 literature review which describes concepts
definitions criteria and content of innovation and on work for the process of
collection of innovative practices within Work Package 3 The latter work
which began in February 2012 developed initial types and criteria for
assessing innovation These are given in full in the report of that work
package and are shown in an abbreviated form in Appendix 1 of this report
2 Eleven partner organisations and a member of the advisory board took part
in a teleconference discussion concerning aspects of criteria development in
March 2012 This identified the key research questions for Work Package 2
as
a What changes in social political economic and technological
development are driving changes in social services (see point 22 in
WP2 description)
b What types of innovation developments are being used in responding
to these changes (see point 23 in WP2 description)
3 Further literature research was undertaken in order to identify specific issues
relating to current societal challenges which act as driving forces for social
service innovation and to place innovation in social services within a dynamic
theoretical context
4 The Consortium members took part in a scenario planning exercise to
assess societal challenges which are driving forces for innovation in social
services now and into the future The results of this exercise were discussed
at a Consortium meeting in June 2012
5 Work packages 3 and 4 were managed through a parallel process all of the
first four work packages influencing each other
6 Criteria for the analysis of innovation were agreed at the Consortium meeting
and the framework developed
7 The criteria were then used for the final selection of projects which is
reported in Work Package 4 (Eurich and Strifler 2012)
6
This report draws very much on the contribution of all the partners although
responsibility for writing it lies with the University of Southampton UK
The report begins with a brief review of the background theoretical concepts
relating to how innovation developments can be understood against knowledge and
practice development in social services It goes on to present the INNOSERV criteria
framework and to explore each of its components
2 Innovation service development and social change paradigm
development and service development
The assessment and understanding of innovation in social services takes place
within a number of organisational and cultural contexts
Our understanding of what is normal and what is new informed by
o Cultural assessments of what is safe and a reliance on lsquoconfirmedrsquo or
accepted knowledge
o The capacity to take risks and try out new ideas in practice or apply an
existing idea in a new situation creating new outcomes
The legal and political environments in which services are developed and
whether they promote adoption of new ideas and practices
In the area of social services these kinds of developments are embedded in a
number of sociologically derived factors including
Local social power structures
Economic capacity or constraint
Political ideologies
Professional ideologies and expertise
These variously integrate into a number of understood social lsquoparadigmsrsquo which
support or inhibit innovatory change Paradigms can support change by enabling
innovative developments to occur to improve the quality or functioning of social
systems within the prevailing paradigm These paradigms can also inhibit thinking
and action which might challenge the fundamental basis of the paradigm
A number of innovative developments can also accumulate in a system and which
collectively begin to challenge the basis for the paradigm itself These may support
the shift into a new social paradigm and inform influence and even radically alter
the way social systems work and develop
An example of this in practice is how the understanding and legal acceptance of
equality for people with disabilities particularly learning disabilities grew from a
number of innovative developments
lsquoNormalisationrsquo (Wolfensburger 1975) proposed that society should include
people with disabilities within the range of normal human existence
The de-institutionalisation of care which can for example be traced to
people with learning disabilities being supported to live in ordinary domestic
settings rather than specialist hospitals in British Columbia Canada
alongside other similar development in other settings
The lsquoindependent livingrsquo movement through which people with disabilities
argued that they should manage their social supports to meet their own
7
personal objectives rather than accept the standardised offerings of social
services organisations
The development of a lsquosocialrsquo rather than lsquomedicalrsquo model for how disability
should be described and understood
Each of these was an innovation some more challenging to the prevailing lsquocarersquo
paradigm than others During the last years of the 20th
century together they
accumulated to deliver a change in the fundamental paradigm informing most
European social systems so that what became an lsquoequalitiesrsquo based framework now
underlies the basis for these social systems (See for example Oliver 1990)
In practice of course these developments occurred simultaneously and in different
places The lsquoequalitiesrsquo arguments developed in the political domain at the same
time and informed and were informed by the practical innovations The
accumulation of the ideas to challenge legal frameworks and care systems occurred
in different ways in differing national contexts The pace of such changes taking
place in Eastern European countries now seeking to adopt these ideas in a single
often politically driven change illustrates an extreme form of lsquoinnovationrsquo adoption
This kind of development reflects processes of knowledge development identified
by Kuhn (1962) as lsquoscientific revolutionrsquo Kuhn noted that developments can occur
within what he calls lsquonormal sciencersquo until individual discoveries appear to challenge
the prevailing paradigm Some accommodations are often then made to the
paradigm but then once enough discoveries appear to challenge the basis of the
prevailing paradigm a new model has to be formed to accommodate the
discoveries lsquoNormalrsquo science can then resume within the new paradigm until this is
then in turn challenged The generation of a new paradigm also creates the
opportunity for new hypotheses which can be tested to form an expanded range of
ideas and knowledge These theories are complex and have developed a number of
critical channels for understanding how knowledge development is shaped or
limited For example some paradigm frameworks disable discovery by forcing a
rigid linguistically determined structure on knowledge development which disables
or actively prevents discovery (see for example Lakatos and Musgrave 1970)
This approach helps to understand how innovative developments in social services
relate to models of social change (see for example Sullivan 1987) Innovations can
occur within social systems but then accumulate to create or require a new social
model for social services The new social lsquomodelrsquo then generates a number of
innovations within the new framework so the equalities based social systems for
people with disabilities continue to generate for example new ideas in
employment for people with disabilities as a part of the lsquoindependent livingrsquo
concept
Innovation development therefore takes place in a dynamic environment Social
services innovations are informing social change and vice versa In order to identify
future innovation trends in social services it is important to understand how
changes in wider society will generate demands for and the development
space for innovation in social services
social services innovation will itself generate new opportunities for social
change
Using this kind of theoretical underpinning this report draws on the INNOSERV
innovation criteria developed in Work Package 1 and reviews the impact of key
societal changes to identify a set of relevant theoretical trends
8
3 Developing and defining innovation criteria
A review of the INNOSERV Work Packages 1 - 3 was undertaken at a meeting of
consortium members in June 2012 The INNOSERV Work Package 1 literature review
(Crepaldi et al 2012) identified a variety of definitions of innovation in services
service innovation and social innovation The literature review provided a first
working definition of innovation in social services shown in box 1 below and also
identified an extensive list of criteria for innovation which is included as appendix
2 This Work Package (2) contributes analysis of the key social challenges driving
innovation in social services Work Package 3 involved the collection of innovative
practice examples using some initial categorisation of innovation (see appendix 1)
BOX 1 INNOSERV first working definition of innovation in social services Innovation in social services can be defined as a type of social innovation process Innovation of social services is delivering services in another way as an answer to current and future challenges in society It mainly concerns (i) designing and implementing new social services to face new needs or unmet needs (ie types of services offered to face autism migrants with an irregular status violence against women) (ii) introducing new social services (or new mechanisms or practices) new interfaces with clients or new practices in social work in pre-existing social services Novelty improvements (effectiveness and efficiency) and sustainability are only first set of criteria to identify innovation in social services Values and the socio-cultural foundations of innovations in the social sphere should be considered Firstly in dealing with social services 1 respond lsquoto pressing social demands which are not addressed by the market and are directed to vulnerable groups in societyrsquo 2 address societal challenges at a level in which the boundary between social and economic blurs and societal challenges are directed towards society as a whole 3 generate systemic changes in changing attitudes and values strategies and policies organisational structures and processes delivery systems and services (Europe 2020 strategy Executive Summary EC) Social services innovations can be considered as ways to enhance processes and the outcome of social innovation Secondly situating social services within a social innovation framework means to focus on ways processes and mechanisms activated by social services that are able (a) to cope with more pressing social needs (b) to stimulate new solutions mobilizing peoples creativity and connecting people ideas and resources to a context of limited resources and rising costs (c) to be able to see social challenges also as opportunities (EC 2010 Murray Caulier-Grice Mulgan 2010) Crepaldi et al 2012 25-26
9
Following the review of these work packages the key elements of innovation for the
INNOSERV project were identified as
relevance to current and future societal challenges
type of innovation response
novelty
improvement
sustainability
context of innovation
These elements were incorporated into the INNOSERV criteria framework developed
to link these key innovation elements together The framework is shown in box 2
Box 2 The INNOSERV criteria framework linking aspects of innovation
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
10
The core of the framework focuses on the ways in which key innovations respond to
drivers and challenges It links distinct types of innovation criteria First there are
those criteria which together define innovation type of innovation or response
novelty and hallmarks of innovation including context improvement and
sustainability Linked to these are drivers or key societal challenges driving
change in social services and other challenges prompting innovation
The remaining sections of this report provide a rationale and explanation of each of
these five separate aspects that make up the framework along with definitions and
explanations of the individual elements within each to provide an analysis against
which the remaining developmental phases of the Innoserv programme can be
assessed
31 Innovation responses innovation in practice
The INNOSERV Work Package 1 literature review and collection of examples has
helped to explicate innovation operating at different lsquolevelsrsquo within service systems
The levels identified in the literature review are shown in summary form in Box 3
and are provided in full including examples in appendix 2
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
11
From this five types of response are detailed within the INNOSERV criteria
framework new service new form of delivery new form of governance new form of
resourcing and new way of evaluation The meaning of these five levels is provided
in table 1 and examples are given to illustrate this It should be noted that the
levels of response are not necessarily exclusive and a specific practice innovation
may fall into more than one category
Box 3 identified levels of innovation in social services
organizational level (ie organization of the provision of social services
type of service target group delivering logics)
regulatory and legislative level (lsquohow services are regulated organised
provided and financed the modalities of service provision the types of
relationships between external service providers and public authoritiesrsquo
EC 2006 p 8)
organizational level ndash connection and cooperation (partnership
networks governance)
professional level (social work methods and practices) -
users level
conceptual level and values
public policy level (policy framework programs and social policies)
financial and economic sustainability level (and scaling-diffusion-
transferability of innovation)
evaluative level and attention to quality (quality standards)
Crepaldi et al 2012 98-99
12
Table 1 Levels of response
Response Definition Example
New service New or improved
product of the scheme
or process
Personalised instead of
generic service
New form of delivery New or improved means
by which the outcome is
achieved
Self-help or social enterprise
instead of government agency
New form of
governance
New or improved way
the scheme or process is
managed and where it
draws authority from
Co-operative or user managed
instead of public service
New form of
resourcing
New or improved
financial human or
physical inputs to the
scheme or process
Grant-funded collectively
staffed organisation instead of
professionally managed
government agency
New way of
evaluation
New or improved
parameters by which
success is judged
User assessment of
effectiveness instead or
professional determined
criteria
It is important to note that innovation within a service is more challenging to define
and measure than innovation in the sense of a product (OECD 2005) while a
product is a tangible entity innovation within service provision can be a either a
product or a process and can occur at different levels of service provision and there
are a number of potential complexities which may inform the structure set out in
table 1
Phills et al (2008) for instance state that social innovation can be
ldquoa product production process or technology (much like innovation in
general) but it can also be a principle an idea a piece of legislation a social
movement an intervention or some combination of themrdquo (39)
In discussing public sector services Hartley (2005) emphasises that innovation is
ldquonot just a new idea but a new practicerdquo (27) and argues therefore that definitions
need to recognise practical impact For services this impact might be at one of
several levels
The organisation literature on innovation offers the initial distinction between
product and process innovation to which other types of innovation have been
added such as position and paradigm innovation (Tidd and Bessant 2009) For
social service oriented innovation further types are added
For example Hartley (2005) identifies the levels of product service process
position strategic governance and rhetorical innovations Hochgerner (2011) adds
social types of innovation to include roles relations norms and values
13
Osborne and Brown (2005) critique a number of typologies to classify innovation
from the management literature They point out that the dichotomy between
process and outcome makes them alternatives whereas an innovation and
particularly innovation in services can be both With services there is often not a
distinct separation between product and process with production delivery and
consumption of services often occurring simultaneously (OECD 2005)
32 Novelty
The next aspect is innovation is novelty In terms of novelty a three way
categorisation is proposed for INNOSERV new perspectives on old needs or
problems new practices for old needs or problems a new practice for a new need
The categorisation reflects the need for innovation to address both existing needs
and new needs Again there is much discussion in the literature about novelty in
relation to innovation Two points are addressed which can be summarised as
lsquowhat degreelevel of novelty equates to innovationrsquo and lsquonew to whomrsquo
The first distinction to be made is between different levels of innovation
ldquoThere are degrees of noveltyrunning from minor incremental
improvements right through to radical changes which transform the way we
think about and use them Sometimes these changes are common to a
particular sector or activity but sometimes they are so radical and far-
reaching that they change the basis of societyhelliprdquo (Tidd and Bessant 2009
27)
Tidd and Bessant usefully break down the incremental-radical continuum as lsquodoing
what we do betterrsquo lsquonew to the enterprisersquo and lsquonew to the worldrsquo (Tidd and
Bessant 2009 38)
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
14
While for some writers a change must be radical or pattern breaking in order to be
innovation it has been argued that within services innovation can be small
adjustments (Fuglsang 2010) Fuglsang in fact argues for a view of innovation in
public sector services as a process of building of skills and expanding routines (68)
The second part of the argument lsquonew to whomrsquo is whether innovation relates to
absolute first use A common to view of innovation is not just those elements
developed within an institution but also those adopted from others (for example
see OECD (2005) for business sector innovation Phills et al (2008) regarding social
innovation Hartley (2005) and Koch (2005) in relation to innovation in public
services) Phills et al (2008) for example state
ldquoAlthough innovations need not necessarily be original they must be new to
the user context or applicationrdquo (Phills et al 37)
Osborne and Brown (2005) purport that most studies consider newness as new to a
person organisation society or situation but not necessarily first use (2005 120)
The authors go on to argue that these are in fact different forms of innovation
differently termed as objective and subjective innovation (Kimberly 1981) or
intrinsic and extrinsic innovation (Downs and Mohr 1976)
Hartley (2005) expounds the dissemination and adaptation of innovation to other
contexts as particularly important for public sector services arguing that public
goals ldquocan be enhanced through collaborative arrangements to create share
transfer adapt and embed good practicerdquo (27) She terms this ldquorsquolateralrsquo innovationrdquo
(33) of good practice adoption and adaption
An example of this approach to defining innovation within social services is seen in
the UK Government policy document on innovation within the National Health
Service which states
ldquoinnovation is as much about applying an idea service or product in a new
context or in a new organisation as it is about creating something newrdquo
(Department of Health 2011 9)
15
33 Hallmarks of innovation
Within social service systems it is not sufficient to focus only on novelty as a
marker of innovation In addition the INNOSERV framework includes certain
hallmarks of innovation including assessment of context quality and sustainability
331 Contextual fit
Different innovative approaches need to fit within different service framework
contexts and need adaptation to those contexts Drawing further on the above
discussion of novelty INNOSERV employ this to mean new to a given (for example
national) context This will reflect the diversity of social service contexts within the
European Union Case studies will also consider transferability of an innovation
from one context to another
332 Improvement in quality
ldquoIn public servicesinnovation is justifiable only where it increases public
value in the quality efficiency or fitness for purpose of governance or
servicesrdquo (Hartley 2005 30)
It is commonly understood that innovation is about improvement as well as novelty
Hartley (2005) offers a model which sets out the possible relationships between
innovation and improvement These relationships are for organisations showing no
improvement and no innovation improvement but no innovation innovation but no
improvement innovation and improvement Important points to highlight from this
model relate to innovation but no improvement first that innovations may not
always lead to success and a level of failure is to be expected second that
innovation can lead to increased but undesired choice loss of performance due to
the process of learning and innovations that are ultimately of no value In terms of
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
16
what is to be measured as improvement Hartley maintains that beyond
improvements in service quality and fitness for purpose wider issues of public
value should be considered
The difficulties of measurement and evaluation of innovation in social services need
to be highlighted as the measures of success within a social project are difficult to
define (Bason 2010 Murray et al 2010) Improvement of social services can
include improved quality of life and access to economic and social opportunity
These issues may relate differently in the fields of health welfare and education
For instance quality of life within health may relate to physical health and mental
wellbeing at different stages of life within welfare issues such as equality of access
to housing cultural and community activities and employment are important
The INNOSERV case studies will include available information on the outcomes of
the innovative project although these will likely vary in terms of types of
measurement used by the projects
333 Sustainability
ldquoInnovation is not just about the originating idea but also the whole process
of the successful development implementation and spread of that idea into
widespread userdquo (Department of Health 2011)
It is recognised that change through innovation needs to be sustainable (Bereiter
2002) Achieving a sustainable innovation may involve streamlining of ideas and
altering them to work in everyday practice (Murray et al 2010 12) The
Normalisation Process Model offered by May and colleagues (May et al 2007 May
et al 2009) provides a theoretical explanation within the context of health care of
the processes through which interventions become embedded in practice and then
integrated and sustained
17
4 Drivers of innovation key societal changes
Innovation within social services needs to be relevant to key social challenges and
changes This relates to the purpose of social services in responding to pressing
social demands and societal needs It is therefore important for the INNOSERV
project to have an understanding of the key social challenges and changes driving
innovation to inform the lsquotheoretical trendsrsquo influencing future innovation
requirements As part of this work package we have therefore sought to identify
social challenges and changes which may act as driving forces of innovation and
shape the development of social service lsquoparadigmsrsquo and hence future social
change
Using a lsquoscenario planningrsquo methodology borrowed from management science can
help to test the limits to any paradigm and identify where new paradigm models
may be needed in the future This in turn should help to identify where future
research interests could be located to explore not just opportunities for innovation
within the current paradigm but also where socially driven change is creating new
opportunities (or indeed requirements) for social and social services innovation
Further these challenges feed into social service provision in terms of an imperative
to address new needs and level of need and issues of rising costs
The INNOSERV project undertook such a scenario planning process the outcomes
of which inform what follows here Using an extended literature study on future
social challenges in the European context a number of key factors promoting a
response from and requiring change in social services were identified Individual
partners made further analysis of the important social challenges within their own
national context The factors were synthesised into a table of key social challenges
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
18
(see appendix 3) separately for health welfare and education sectors although
there was much overlap in the challenges relating to each sector
Small groups involving two country based teams in each case took each social
challenge and considered how it may change and develop given current
understandings of the forces affecting change (some forces may promote change
and some may block change) These were considered against potential political
developments economic developments socialsociological change technological
development legallegislative changes and environmental factors with a focus on
volume nature depth timeframe and scale of importance in influencing future
developments in social services
This work informed extensive discussion at the INNOSERV June 2012 Consortium
meeting with regard to the impact of key future developments on innovation and
the choice of projects which should be used to test key innovation developments
and their relevance to future service development
Relevance is represented in the INNOSERV criteria framework by the lsquodriversrsquo box
which includes a number of examples The most significant social challenges and
changes which were identified by the Consortium as most pertinent to innovation in
social services are listed in table 2 (page 19) and are explored further in the
remainder of this section The selection of projects as case studies has included
analysis of which of these social challenges and changes are being addressed (see
Work Package 4 report Eurich and Strifler 2012)
41 Demographic change as a key societal change driving innovation in the
health and welfare social service sectors
Demographic change was identified as a driving force of innovation in both health
and welfare services in Europe Current demographic change is resulting in
increased numbers of people living longer into old age with a particular increase in
the numbers of people aged over 80 This is alongside a reduction in the numbers
of people of working age in part due to a declining birth rate Further socio-cultural
change is leading to concerns about levels of informal care for older people
While many people will want to live active lives in old age some will live with long
periods of ill health and will have complex care needs resulting from multiple co-
morbidities Most however prefer to live as independently as possible
Questions arise about the ability to meet these increasing care demands from
declining tax income bases In addition the specific needs of elderly patients with
dementia represent a unique challenge for nursing staff and the organisation of
nursing services Financing of the rising health care costs for public agencies or for
health insurance schemes requires sustainable solutions and structural reforms
Traditional models of hospital lsquoacutersquo care may not necessarily be appropriate for
meeting these health care needs
This all highlights the need to find alternative solutions to care needs including the
use of technology and reliance on informal carers Current responses which are
relevant to this driver include integration of health and social care services to
increase cost efficiencies use of technological solutions to enhance self care and
care at home and new paradigms such as Active Ageing
19
Table 2 Key social challenges and changes driving innovation
Social
challengesocial
change driving
innovation
Meaning Social service sector
in which driver is key
Demographic
change
Increase in numbers of over 65s Greatest
increase in over 80 age group Increase in
old age dependency ratio
Health sector
Welfare sector
Aspirations Rising expectations of citizens for better
quality of lifebetter care
Health sector
Education sector
Cross sector services of
education and health
Lifestyles Increase in certain diseases related to
obesity alcohol and drug consumption
and stress diabetes liver disease anxiety
and depression
Health sector
Cross sector services of
education and health
Technology Access to information new media
technology
Health sector
Continued
inequalities
Continued economic inequality
unemployment continued poverty
including child poverty continued
institutionalisation continued inequality for
people with disabilities ethnic minorities
gender inequalities impact of socio-
economic status on health outcomes
Welfare sector
Education sector
Cross sector services of
education and health
and welfare and
education
Independent living The approach now adopted by disabled
people to live as ordinary members of
society and in their chosen domestic
setting
Welfare sector
Social roles Changing families increase in single
households increase in single parent
families changing generational relations
(due to longer life expectancy) reduction in
extended families
Changing gender roles rising female
employment rates
Welfare sector
Education sector
Organisational
changes
Creating new organisational forms
application of more responsive
management processes performance
management culture
Welfare sector
Changing
management
styles
Application of more responsive
management processes
Education sector
Cross sector services of
education and health
20
42 Aspirations as a key societal change driving innovation for health and
for education service sectors
Citizen aspirations were identified as a key societal change acting as a driving force
for innovation within both the health and education sectors and across the
boundary of these sectors Across Europe citizens are expecting a better quality of
life including improved outcomes from health and care services and reduced
inequalities
In terms of the health service sector this both derives from and manifests itself in
a population which is more informed about health issues Consequently patients
wish to be more involved in decisions about their health and their health care
options and are more willing and able to participate in the management of their
condition There is less deference to the medical profession and greater willingness
to make demands on health services There are a growing number of patient led
movements which are challenging some medical traditions
This aspect is fundamental both to everyday practice and to the future development
trajectory for health care services While most health aspirations are limited by
current knowledge and medical skill as research and medical advance offer new
choices and opportunities but at greater costs there will be difficult questions for
political debate This could well result in very different more personalised and
lsquopatient managedrsquo models of health care support
In terms of the education service sector individualism and the connected
aspiration of lsquobeing involvedrsquo has been an increasing trend over the past years and
is expected to keep gaining importance This is not only reflected by agendas of
individually shaped curricula or learning arrangements in school but also by the
opening of the public (ie government funded) school system towards involvement
of the community (seniors in school corporate sponsoring external initiatives of
informal learning and personality formation etc) This is reflected in a similar way
in higher education (eg service learning) and adult education (lsquolearning regionsrsquo)
Across the boundary of health and education aspirations coupled with medical
advance lead to a desire for independence of disabled people and those with long
term conditions This highlights the need for health programs focussed on self
esteem
43 Lifestyles as a key societal challenge driving innovation in the health
service sector and also in the cross sector services of health and education
A key social challenge acting as a driving force for innovation for the health sector
and in the cross sector services of education and health is a recognised growth in
lsquolifestylersquo related conditions arising from unhealthy behaviours such as poor diet
alcohol consumption and smoking (although there is limited evidence of a decline
in smoking rates as its harmful effects are less well tolerated) Political investment
in public health is recognised as an important strategic ambition but often not
matched by financial resources Questions about personal responsibility are also
being asked with suggestions that people with poor health behaviours should not
be given the same priority to responsive health care services As other factors
impacting on health outcomes become more responsive to medical advance these
factors are growing in importance in their impact both on wider society and in
improving overall health outcomes
21
44 Technology as a key societal change driving innovation in the health
service sector
The growth in internet and web based technology is leading to an exponential
growth in access to information and new forms of communication More people
now use the internet as their primary health care information resource Web
lsquocommunitiesrsquo are linking and thus empowering people faced with similar health
challenges Telehealthcare solutions to on-going care needs are becoming more
widely available and are changing the patterns of demands for some health care
services Other new technologies for example in transport and in home assistance
devices are enabling greater independence for disabled people
As future generations use and expect more from access to information and
communication services health care services will have to respond to both the
demands and the opportunities created by such technology Technology can be
seen as both a driving force for innovation and as an enabler of change
45 Continued inequalities as a key societal challenge driving innovation in
welfare and education service sectors also in cross sector services of
education and health and welfare and education
Continued inequalities were identified as a key driving force for innovation within
both welfare and education sectors and in services which straddle the boundary
between education and health services and education and welfare services
Inequalities stem from issues of migration social originbackground
unemployment disability and gender and have been a source of the social
upheaval which has been seen in Europe in recent months
Within health education the link between socio-economic status and health is clear
with people from lower socio-economic groups experiencing poorer health and less
likely engaging in health promoting behaviours In the case of migrants health
messages need to be delivered in a culturally appropriate manner
46 Independent living as a key societal change driving innovation in the
welfare service sector
In terms of disability the emergence and spread of the independent living
philosophy has been a key change driving innovation in the welfare service sector
Typically innovation in this field involves new stakeholder roles with a much more
proactive role for service users in all stages of service provision design
implementation monitoring and fine tuning of services as well as a role in
coordination of different entitlementsservices andor administration and reporting
requirements The boundaries are being pushed further deeper and wider every
day Starting from persons with physical disabilities services are now promoting
active involvement of persons with severe mental disabilities a development that
was deemed impossible only 30 years ago
47 Social roles as a key societal change driving innovation for welfare and
for education service sectors
Changing social roles were identified as a key challenge driving innovation within
the welfare and education sectors These changes are within families and of the
family itself and include changing gender roles and changing family structures (eg
increase in single parent families increase in the numbers of older people living
alone) Families seem to be becoming a sphere of public or community interest
rather than an exclusively private one
Proper lsquosocializationrsquo of children is the key to building viable and sustainable
futures for individuals Early stage family intervention is necessary to prevent the
22
very emergence of conflicts lsquoExternalrsquo interventions often do not reach every day
interaction and thus the root causes of problems This is of significance for family
based projects as well as for care institutions and education providers
48 Organisational changes as a key societal change driving innovation in
welfare service sectors
The shifting of provision of services from the public sector into other sectors such
as independent profit making companies and social enterprises creates new
opportunities for innovation In addition there is an increasing move to provide
services locally in order to be more relevant and responsive and a move to
community based models of care
49 Changing management styles as a key innovation challenge for the
education service sector and in cross sector services of the health and
education sector
Connected to individualism as well as new social roles of individuals family
community and institutions management styles shaped by multi-stakeholder
involvement are gaining importance Community based models do not only increase
the complexity of players involved in the lsquovalue creationrsquo process but also the
enhancement of skill development and personality formation as well as the
fertilization of the educational landscape by innovative ideas expertise and
practices of diverse partners The latter fact also stimulates an increase in cross-
sectoral services (education health and social services) Simultaneously this
situation increases the necessity to spot choose and foster the lsquoinfluencesrsquo and
lsquocombinationsrsquo which realize the highest value through the assessment of social
impact
Increased emphasis is also being placed on illustrating and monitoring
performance Impact measurement and associated tools and practices gain
overarching importance
In terms of changing management styles within the health and education sector an
important aspect is the cooperation of different stakeholders and the involvement
of the community or userrsquos perspective Linked to increased user aspirations
people would like to take part in the development of programs and services With
their special knowledge of their condition for example they can contribute their
expertise within social services
23
5 Other key challenges driving innovation
Sociatal challenges and changes are of course only one driving force of innovation
In addition to these there are other meso and micro level factors which also drive
innovation These include research and development leading to new knowledge
professionally led innovation in response to users needs increasing costs of service
provision and demands for greater efficiency per se and specific political contexts
These other forces are included in the INNOSERV criteria framework in the
lsquochallengesrsquo box These factors are not a key focus for selection of projects for
INNOSERV as they are often very situation specific but will be noted in the case
studies where relevant The factors which prompt or trigger specific innovations
whether socially based or otherwise are not are not mutually exclusive (Bason
2010) and in there is a complex and interacting relationship between a variety of
factors for any given innovation lsquoinstancersquo In addition there are well documented
factors which act to inhibit the development of innovative responses (see Crepaldi
et al 201215)
This work package has sought to identify generic criteria and drivers but it must be
recognised that the dynamics of individual settings and local factors will impact on
the actual processes of adoption
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
24
6 Conclusions and next steps
This report has presented the framework which has been used within the INNOSERV
project to support the choice of innovative case studies and to assist in identifying
the innovation phenomena potential and processes important to future research in
this area The framework has been used to select projects as case studies (see Work
Package 4 report Eurich and Strifler 2012) The framework interlinks aspects of
innovation (novelty type context improvement sustainability) with analysis of
challenges and changes which are acting as driving forces of innovation in social
services As the project is future facing it is proposed that key social challenges
and changes are likely to inform the development of new change paradigms for the
delivery of social services across Europe The framework will inform further
development and testing of concepts through the next stages of the INNOSERVE
programme This process will result in descriptions for the key areas in which future
research on innovation in social services should be taken forward
25
7 Bibliography
Bason C (2010) Leading public sector innovation Co-creating for a better society
Bristol The Policy Press
Bereiter C (2002) Design research for sustained innovation Cognitive Studies
Bulletin of the Japanese Cognitive Society 9 321-327
Christensen CM and Overdorf M (2000) Meeting the Challenge of Disruptive
Change Harvard Business Review March-April
Clark M and Goodwin N (2010) Sustaining innovation in telehealth and telecare
WSDNA briefing paper London The Kings Fund
Crepaldi C De Rosa E And Pesce F (2012) Literature review on innovation in
social services in Europe (sectors of Health Education and Welfare
Services)INNOSERV Work Package 1 report
Department of Health (2011) Innovation Health and Wealth Accelerating Adoption
and Diffusion in the NHS London Department of Health
Eurich J and Strifler A (2012) European compared selection of innovative social
services INNOSERV Work Package 4 report
Fuglsang L (2010) Bricolage and invisible innovation in public service innovation
Journal of Innovation Economics 5 67-87
Greenhalgh T Robert G Macfarlane F Bate P Kyriakidou O (2004) Diffusion of
innovations in service organizations systematic review and recommendations
Milbank Quarterly 82581-629
Hartley J (2005) Innovation in Governance and Public Services Past and Present
Public Money and Management 25127-34
Koch P and Hauknes J (2005) On innovation in the Public Sector Publin report no
D20
Kuhn T (1962) The Structure of Scientific Revolutions Chicago The University of
Chicago Press
Lakatos I and Musgrave A (eds) (1970) Criticism and the growth of knowledge
London Cambridge University Press
May
C Finch T Mair F et al ( 2007) Understanding the implementation of
complex interventions in health care the normalization process model BMC Health
Services Research 2007 7148 doi1011861472-6963-7-148
May et al (2009) Implementing Embedding and Integrating Practices An Outline of
Normalization Process Theory Sociology 43 535-554
Murray R Caulier-Grice J and Mulgan G (2010) The Open Book of Social
Innovation London The Young Foundation
26
OECD (2005) Oslo manual Guidelines for collecting and interpreting innovation
data 3rd
edition
Oliver M (1990) The politics of disablement Basingstoke Macmillan Education Ltd
Osborne S (1998) Naming the Beast Defining and Classifying Service Innovations
in Social Policy Human Relations 51 9 1133-1154
Osborne S and Brown K (2005) Managing Change and Innovation in Public Service
Organizations London Routledge
Phills JA Deiglmeier K and Miller DT (2008) Rediscovering Social Innovation
Stamford Innovation Review 6 4 34-43
Sullivan M (1987) Sociology and Social Welfare London Allen and Unwin
Tidd J and Bessant J (2009) Managing Innovation Integrating Technological
Market and organizational Change 4th
edition Chichester John Wiley and Sons
UK Government Department of Health (2011) Innovation Health and Wealth
Accelerating adoption and diffusion in the NHS London Department of Health
Wolfensburger W (1975) The principle of normalisation in human services Toronto
National Institute on Mental Retardation
27
8 Appendices
Appendix 1 Summary of types and criteria of innovation used in Work Package
3 to identify practices
Identification of social service
Field(s) of service
Logic(s) of service
Self help or mutual aid logic Social care logic Multi-stakeholders logic Social
movements logic Combination
Activities of services delivered
Assistance for persons faced with personal challenges or crises (debt unemployment
drug addiction other) (Re)integration of persons into society (rehabilitation language
training for immigrants other) Services to the labour market (occupational training)
Social housing for disadvantaged groups Care (for the elderly children families )
Treatment and support of people with physical illnesses Treatment and support of
people with mental health problems Combination
Status of the provider organization
Public organization (governmental) Private organization ndash nonnot for profit Private
organization ndash profit Volunteer association Cooperative company or mutual company
Familyneighbourhood Civil society network Combination Other
Target group
Children Youngsters Elder people Unemployed people Poor people Immigrants
Disabled people People with chronic diseases ndash long-term health problems People with
acute or short term health problems No specific target group (eg territory-based social
services provision aiming at strengthen social ties) Combination Other
Size of the organization
Innovation
Type of innovation
New forms of organization resources hybridization new targeted actions new services
non-structural practices other
Innovative character
do the service practices appear to be something new in the field of social services
Origins of innovation
Supply side demand side broader operating factors
Impact on service performance
Effectiveness of service delivery
from user perspective cost effectivenesscapacity building sustainability of
innovation
Quality of provision
28
Socialization quality of life as judged by users and beneficiaries more inclusion
lower risk on exclusion participation of the user transition from institutional to
community based care
Potential wider effects
Promoting social and health equality sustainability new skills and jobs
increased social rights affordability of adequate and high quality health and long-
term care promotion of equality and non-discrimination equal access to adequate
provision
Transferability of innovations between national contexts
29
Appendix 2 levels of innovation identified within INNOSERV Work Package 2
literature review
Organizational level (policy organizational sectors)
New social services designed to face new needs or unmet needs
Search for new solutions to old needs new mechanisms or practices introduced in
preexisting
social services
to improve access to social services (ie more information increased
professionalism in
social work sector)
to guarantee entitlements (rights) for specific groups or minorities
to satisfy the demand for social services in a more complete and broad way
(holistic
approach)
to guarantee more participation and inclusion of citizens
New and increased Cross-Sectoral social services
Cross-Sectoral social services (ie teaching art to children while helping their mothers
for
job seeking and offering jobs for young artists)
Integrated care practices
Tearing down walls between sectors and the role of informal care
Sharing of knowledge
Better integration of Health and Social sector services
Territory based social services that contribute to the creation of training and job
opportunities for disadvantaged people
Solidarity-based social services
Social mediation for impaired and weakened people
Easy access to housing for poor families
New interfaces with clients
Logic(s) of service Self help or mutual aid logic Social care logic Multi-stakeholders
logic
Social movements logic
The development of the self-help sector
Actors New organizations (Cooperative society for social service provision ndashSCOP
Cooperative society as social enterprise with userrsquos involvement ndashSCIC)
New legal forms within structured public frameworks (Italy social cooperatives)
New provider organizations and existing organisations refashioned by new dynamics
New roles and relations among actors
New private organizations for profit and non-profit
Management style in the organization
Regulatory and legislative level
New architecture of the provision system
Socially responsible public contracts and social clauses (outsourcing)
Adherence to EU standards in transitional economies
Impact on institutional framework that shape innovation in social services
New arrangement between one or more government agencies andor external
organization
Organizational level ndash Connection and Cooperation (governance and partnership)
New networks and social movements established in order to design deliver and
finance
social services
Cooperation between sectors actors and different forms of provision
Cooperation between local actors
Increasing communication responsiveness
30
Utilizing connectivity and interdependencies
Modification of organizational systems (models of governance work organisation
number
of involved stakeholders in governance)
Public sector and local authorities as promoters of innovation and promoters of
crosssectoral
policy strategies
Third sector and user as promoters of innovation
Volunteer workers and initiatives launched by a group of citizens
Third sector and userrsquos engagement design (co-design and re-design services)
Joint decision process
Decision-making power not based on capital ownership
Employee and user driven innovation
Partnerships with users family carers and user organizations
Partnership between service users practitioners and academics
Community-based and participative health network in a local territory
Collaboration between public and volunteer organisations (NGOs) or between civil and
local
networks in collaboration with public organisations and social enterprises
New techniques for partnership building and functioning
Impact on social and power relations
Professional level (practitioners)
New practices in social work
Innovative tools (ie Theatre of the Oppressed) and the use of participated methods in
social
work (ie self-help group)
Networking
Individualised supports
New professional skills in social work
The use of informatics and new technologies in social work
Users
Participation and involvement of final users of services in designing delivering and
evaluating social services
Involvement of final users in promoting equality effectiveness and control and
adherence
to the needs of users
Conceptual Level (and value)
New models of society - Social goals participation user involvement community
benefit
New paradigms underlying a new social service concept or service delivery model (ie
new
inclusion paradigm active ageing)
Relationships and trust
Pursuing diversity
Better adjustment to usersrsquo needs more person centred support
More social services provision in less developed regions
New concept of accessibility of the service (ie for Roma families)
The concept of lsquoprogressive universalismrsquo
The Social Care Model
De-institutionalization and community care Improved home-based and community
services
Gender and diversity perspectives
Anti-discrimination and equality process
Increase of the level of recognition of social values objectives paradigms and goals
New models of interaction leading to social innovation processes
31
Public policy level (policy framework programs and social policies)
The new role of the system governance played by central (or local depending on
national
arrangements) government
Impact on public policies new public policy programme measure or intervention
Joint construction of a space for public action and redefinition of public governance
bodies
and methods
Innovative logics for public policies
Innovating the public sector
The new wide attention on anti stigma policies
E-government
Financial and economic sustainability level (and scaling-diffusion-transferability
of innovation)
New ways to overcome budgetary constraints
New approaches to acquire funding
The involvement of private investors
The introduction of special funds
The purchase of innovative practices by final users
Hybridization of resources (market redistribution and reciprocity resources)
New investment sources
Mobilising community resources taking full advantage of all endogenous resources
Improvement in efficiency and effectiveness
Financial and systemic sustainability Impact on the economy
Economic Environmental and Social Sustainability of Territory based social services
Financial tools necessary to territorial social initiatives and the way to unlock them
Capacity of spreading and diffusion
Evaluative level and attention for quality
Affordability availability and accessibility
New standards expected
New feedback loops from users and specialists
Social services of excellence as for quality efficiency and efficacy
New methods and creative tool-kits to strengthen and renew the quality of social care
services
Low-cost (for user) and high level quality of social services
Quality assurance moderation and accreditation mechanisms
New tools for monitoring social services - hearing all voices (users organizations
practioners staff family and friends)
Action research
Alternative economic and social indicators
Social impact and contribution of innovation in social services to social innovation and
social change ndash Assessment of innovation
Learning approach to evaluation ndash lsquoto learn from failuresrsquo
Developmental evaluation
Specifics for the Health sector
Disability from rehabilitation to integration and then to inclusion
Mental Health from segregation to inclusion and community care
HIV from segregationstigmatization to awareness campaigns for promoting self
protection
Innovation in the area of prevention of treatment and in the introduction of new
technologies
Emphasis on an inter-sectoral controlled and steered care in managed care models
replacement of the traditional insurance model
Integrated services
Technological progress
32
Specifics for the Education sector
Inclusive education
Inclusive education and training in collaboration with the civil society
Multicultural education
Integration of disciplines
Alternative schools non-regular schools and informal education
Link between formal and informal education
Community development based approaches
Connection between regular school and the system of social services
Experiential learning
Human rights education
Working lsquothrough relationshipsrsquo with children and young people
Problem based learning methodology
The lsquomedia educationrsquo The use of comics
ICT in schools
E-inclusion
Networks of schools
Improve supplement reinvent and transform learning
Sustained educational improvement
Learning Beyond the Classroom
Spreading a culture that values learning
More personalized approaches to learning
Using the web
Learning with and by not to and from
33
Appendix 3 analysis of social challenges and changes driving innovation
Welfare
Societal
change as
driving force
of innovation
in social
services
Meaning
description
Related
outcomesother
factors
Examples of innovative
responses
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
Empowerment self-
determination choice
The lsquoassertive userrsquo
Demand for more
individualised services of
better quality
Alternativecomplementary
providers
Personalisation
Co-production (new
userprofessional
relationships)
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demand on services
Potential for poor access
to services (from
communication
problems social
isolation)
Multiculturalism
Integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Declining female
caregiving
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
34
Increased demand for
services demand for
formal care
Continued
inequality
Continued
economic
inequality
unemployment
continued poverty
including child
poverty continued
institutionalisation
continued
inequality for
people with
disabilities ethnic
minorities gender
inequalities
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients
with complex
comorbidities increase
in certain diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing demand for
services Increasing
costsneed to make
limited resources go
further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
Decisions about value
marketization
Technological
development
Access to
information new
media technology
Facilitates self
determination increases
expectations and choice
population better
informed about
conditionsservicesright
s and less deferential
Users better able to
35
mobilise
Increased exclusion of
some groups with limited
access
New models of remote
care provision
Ability to exchange
information on quality
and experience
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Increasing costs
Decisions about value
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Organisational
change changing
management
styles
philosophies
Creating new
organisational
forms application
of more responsive
management
processes
performance
management
culture
Integration of
organisationsfunctions
new approaches to
lsquocommissioningrsquo of
organisationsservices
distortions caused by
lsquolocked inrsquo expenditures
(tertiary health care
residential care)
Decentralisation
deinstitutionalisation
marketization liberalisation
The lsquoenabling
statersquo Political
will fiscal space
Impact of financial
crisis competing
priorities for public
funds
Legacy of category-based
(not needs based) social
protection structural
transition
deindustrialisation
Health
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
EmpowermentSelf-
determination choice
Demand for more
individualised services of
better quality
Users better able to mobilise
Assertive lsquouserrsquo
knowledgeable patient
Alternativecomplimentary
providers
36
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demands on
services
Potential for poor access
to services (from
communication
problems social
isolation)
MulticulturalismTrained
health professionals
move to richer countries
integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Declining female
caregiving
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
Increased demand for
formal care services
Continued
inequalities
Unequal
distribution of
health risks and
health
outcomediseases
by socioeconomic
indicators
Unequal access to
care by social
status geography
gender and
ethnicity
Demographic Increase in
numbers of over
Increase in patients with
complex comorbidities
Increasing demand for care
Decisions about value Active
37
change 65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing costsneed to
make limited resources
go further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
ageing paradigm
Technological
development
Access to
information new
media technology
Self determination
expectations choice
population better
informed about
conditionsservicesright
s and less deferential
Ability to exchange
information on quality
and experience
New models of care provision
(eg telehealth care) new
health management systems
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Changing
management
stylesphilosophi
es
Application of
more responsive
management
processes
Decentralisation
deinstitutionalisation
marketization liberalisation
Lifestyle changes Increase in certain
diseases related to
obesity alcohol
and drug
Increasing
costsdemands for care
38
consumption and
stress diabetes
liver disease
anxiety and
depression
Education
Aspirations Rising expectations
by citizens for
better quality of
life
Self determination
choice consumerism
Education outside of formal
setting
Assertive user
Lifelong learningeducation
Migration Historical (post
colonial) migration
pan-EU migration
refugees
New needs for education
eg language and culture
Inequalities social
fragmentation
Social Roles Changing family
structure increase
in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
changing gender
roles rising
female
employment rates
Need to reconcile work
and family life
Parentingfamily skills
for vulnerable
parentsfamilies
Socialization of children
ndash social and emotional
deficits for children in
some environments
Work with families and
communities
Continued
inequalities
Inequality in
educational
accessattainment
by socioeconomic
status gender
people with
disabilities ethnic
minorities
Culture of failure
Promise to deliver social
mobility and economic
improvement
(Leadbeater and Wond
2010 pp 5-20)
Inclusive and multicultural
education
Differential support for
children from
lsquodisadvantagedrsquo
backgrounds
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients with
complex comorbidities
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
New group of older
39
learners
Technological
advance
Access to
information new
media technology
making learning
available in new
ways
Self determination
expectations choice
lsquoAssertive userrsquo
Increased exclusion of
some groups with limited
access
Changing
management
styles
philosophies
Community based models
Globalization Need to provide
educationtraining
which is suited to
modern knowledge
based global
economies
This report for the InnoServ project (grant agreement nr 290542) is supported
under the Socio-economic and Humanities Programme of FP7
Chris Hawker
Faculty of Health Sciences University of Southampton Building 67 University Road Highfield Campus Southampton SO17 1BJ
Tel +44 (0)23 8059 7968
Email CHawkersotonacuk
5
1 Background identifying and developing innovation trends and criteria
This report identifies theoretical trends and criteria for innovative service
development practices in social services developed by the INNOSERV project as part
of the second work package The trends and criteria have been formed into a
criteria framework to be used in later work packages to inform the choice of project
case studies The purpose of the INNOSERV work programme is to identify the
innovation phenomena potentials and processes important to future research
around innovation in social services
The report draws on the INNOSERV Work Package 1 literature review (Crepaldi et al
2012) which discusses concepts definitions criteria and the content of innovation
in social services plus the work undertaken to identify innovative social services in
Work Package 3 This report builds on that work in order to identify theoretical
trends and criteria for investigating and categorising innovative practices
11 Framework development
This framework and analysis have been developed through the following processes
1 The criteria development draws heavily on the work undertaken within the
INNOSERV Work Package 1 literature review which describes concepts
definitions criteria and content of innovation and on work for the process of
collection of innovative practices within Work Package 3 The latter work
which began in February 2012 developed initial types and criteria for
assessing innovation These are given in full in the report of that work
package and are shown in an abbreviated form in Appendix 1 of this report
2 Eleven partner organisations and a member of the advisory board took part
in a teleconference discussion concerning aspects of criteria development in
March 2012 This identified the key research questions for Work Package 2
as
a What changes in social political economic and technological
development are driving changes in social services (see point 22 in
WP2 description)
b What types of innovation developments are being used in responding
to these changes (see point 23 in WP2 description)
3 Further literature research was undertaken in order to identify specific issues
relating to current societal challenges which act as driving forces for social
service innovation and to place innovation in social services within a dynamic
theoretical context
4 The Consortium members took part in a scenario planning exercise to
assess societal challenges which are driving forces for innovation in social
services now and into the future The results of this exercise were discussed
at a Consortium meeting in June 2012
5 Work packages 3 and 4 were managed through a parallel process all of the
first four work packages influencing each other
6 Criteria for the analysis of innovation were agreed at the Consortium meeting
and the framework developed
7 The criteria were then used for the final selection of projects which is
reported in Work Package 4 (Eurich and Strifler 2012)
6
This report draws very much on the contribution of all the partners although
responsibility for writing it lies with the University of Southampton UK
The report begins with a brief review of the background theoretical concepts
relating to how innovation developments can be understood against knowledge and
practice development in social services It goes on to present the INNOSERV criteria
framework and to explore each of its components
2 Innovation service development and social change paradigm
development and service development
The assessment and understanding of innovation in social services takes place
within a number of organisational and cultural contexts
Our understanding of what is normal and what is new informed by
o Cultural assessments of what is safe and a reliance on lsquoconfirmedrsquo or
accepted knowledge
o The capacity to take risks and try out new ideas in practice or apply an
existing idea in a new situation creating new outcomes
The legal and political environments in which services are developed and
whether they promote adoption of new ideas and practices
In the area of social services these kinds of developments are embedded in a
number of sociologically derived factors including
Local social power structures
Economic capacity or constraint
Political ideologies
Professional ideologies and expertise
These variously integrate into a number of understood social lsquoparadigmsrsquo which
support or inhibit innovatory change Paradigms can support change by enabling
innovative developments to occur to improve the quality or functioning of social
systems within the prevailing paradigm These paradigms can also inhibit thinking
and action which might challenge the fundamental basis of the paradigm
A number of innovative developments can also accumulate in a system and which
collectively begin to challenge the basis for the paradigm itself These may support
the shift into a new social paradigm and inform influence and even radically alter
the way social systems work and develop
An example of this in practice is how the understanding and legal acceptance of
equality for people with disabilities particularly learning disabilities grew from a
number of innovative developments
lsquoNormalisationrsquo (Wolfensburger 1975) proposed that society should include
people with disabilities within the range of normal human existence
The de-institutionalisation of care which can for example be traced to
people with learning disabilities being supported to live in ordinary domestic
settings rather than specialist hospitals in British Columbia Canada
alongside other similar development in other settings
The lsquoindependent livingrsquo movement through which people with disabilities
argued that they should manage their social supports to meet their own
7
personal objectives rather than accept the standardised offerings of social
services organisations
The development of a lsquosocialrsquo rather than lsquomedicalrsquo model for how disability
should be described and understood
Each of these was an innovation some more challenging to the prevailing lsquocarersquo
paradigm than others During the last years of the 20th
century together they
accumulated to deliver a change in the fundamental paradigm informing most
European social systems so that what became an lsquoequalitiesrsquo based framework now
underlies the basis for these social systems (See for example Oliver 1990)
In practice of course these developments occurred simultaneously and in different
places The lsquoequalitiesrsquo arguments developed in the political domain at the same
time and informed and were informed by the practical innovations The
accumulation of the ideas to challenge legal frameworks and care systems occurred
in different ways in differing national contexts The pace of such changes taking
place in Eastern European countries now seeking to adopt these ideas in a single
often politically driven change illustrates an extreme form of lsquoinnovationrsquo adoption
This kind of development reflects processes of knowledge development identified
by Kuhn (1962) as lsquoscientific revolutionrsquo Kuhn noted that developments can occur
within what he calls lsquonormal sciencersquo until individual discoveries appear to challenge
the prevailing paradigm Some accommodations are often then made to the
paradigm but then once enough discoveries appear to challenge the basis of the
prevailing paradigm a new model has to be formed to accommodate the
discoveries lsquoNormalrsquo science can then resume within the new paradigm until this is
then in turn challenged The generation of a new paradigm also creates the
opportunity for new hypotheses which can be tested to form an expanded range of
ideas and knowledge These theories are complex and have developed a number of
critical channels for understanding how knowledge development is shaped or
limited For example some paradigm frameworks disable discovery by forcing a
rigid linguistically determined structure on knowledge development which disables
or actively prevents discovery (see for example Lakatos and Musgrave 1970)
This approach helps to understand how innovative developments in social services
relate to models of social change (see for example Sullivan 1987) Innovations can
occur within social systems but then accumulate to create or require a new social
model for social services The new social lsquomodelrsquo then generates a number of
innovations within the new framework so the equalities based social systems for
people with disabilities continue to generate for example new ideas in
employment for people with disabilities as a part of the lsquoindependent livingrsquo
concept
Innovation development therefore takes place in a dynamic environment Social
services innovations are informing social change and vice versa In order to identify
future innovation trends in social services it is important to understand how
changes in wider society will generate demands for and the development
space for innovation in social services
social services innovation will itself generate new opportunities for social
change
Using this kind of theoretical underpinning this report draws on the INNOSERV
innovation criteria developed in Work Package 1 and reviews the impact of key
societal changes to identify a set of relevant theoretical trends
8
3 Developing and defining innovation criteria
A review of the INNOSERV Work Packages 1 - 3 was undertaken at a meeting of
consortium members in June 2012 The INNOSERV Work Package 1 literature review
(Crepaldi et al 2012) identified a variety of definitions of innovation in services
service innovation and social innovation The literature review provided a first
working definition of innovation in social services shown in box 1 below and also
identified an extensive list of criteria for innovation which is included as appendix
2 This Work Package (2) contributes analysis of the key social challenges driving
innovation in social services Work Package 3 involved the collection of innovative
practice examples using some initial categorisation of innovation (see appendix 1)
BOX 1 INNOSERV first working definition of innovation in social services Innovation in social services can be defined as a type of social innovation process Innovation of social services is delivering services in another way as an answer to current and future challenges in society It mainly concerns (i) designing and implementing new social services to face new needs or unmet needs (ie types of services offered to face autism migrants with an irregular status violence against women) (ii) introducing new social services (or new mechanisms or practices) new interfaces with clients or new practices in social work in pre-existing social services Novelty improvements (effectiveness and efficiency) and sustainability are only first set of criteria to identify innovation in social services Values and the socio-cultural foundations of innovations in the social sphere should be considered Firstly in dealing with social services 1 respond lsquoto pressing social demands which are not addressed by the market and are directed to vulnerable groups in societyrsquo 2 address societal challenges at a level in which the boundary between social and economic blurs and societal challenges are directed towards society as a whole 3 generate systemic changes in changing attitudes and values strategies and policies organisational structures and processes delivery systems and services (Europe 2020 strategy Executive Summary EC) Social services innovations can be considered as ways to enhance processes and the outcome of social innovation Secondly situating social services within a social innovation framework means to focus on ways processes and mechanisms activated by social services that are able (a) to cope with more pressing social needs (b) to stimulate new solutions mobilizing peoples creativity and connecting people ideas and resources to a context of limited resources and rising costs (c) to be able to see social challenges also as opportunities (EC 2010 Murray Caulier-Grice Mulgan 2010) Crepaldi et al 2012 25-26
9
Following the review of these work packages the key elements of innovation for the
INNOSERV project were identified as
relevance to current and future societal challenges
type of innovation response
novelty
improvement
sustainability
context of innovation
These elements were incorporated into the INNOSERV criteria framework developed
to link these key innovation elements together The framework is shown in box 2
Box 2 The INNOSERV criteria framework linking aspects of innovation
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
10
The core of the framework focuses on the ways in which key innovations respond to
drivers and challenges It links distinct types of innovation criteria First there are
those criteria which together define innovation type of innovation or response
novelty and hallmarks of innovation including context improvement and
sustainability Linked to these are drivers or key societal challenges driving
change in social services and other challenges prompting innovation
The remaining sections of this report provide a rationale and explanation of each of
these five separate aspects that make up the framework along with definitions and
explanations of the individual elements within each to provide an analysis against
which the remaining developmental phases of the Innoserv programme can be
assessed
31 Innovation responses innovation in practice
The INNOSERV Work Package 1 literature review and collection of examples has
helped to explicate innovation operating at different lsquolevelsrsquo within service systems
The levels identified in the literature review are shown in summary form in Box 3
and are provided in full including examples in appendix 2
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
11
From this five types of response are detailed within the INNOSERV criteria
framework new service new form of delivery new form of governance new form of
resourcing and new way of evaluation The meaning of these five levels is provided
in table 1 and examples are given to illustrate this It should be noted that the
levels of response are not necessarily exclusive and a specific practice innovation
may fall into more than one category
Box 3 identified levels of innovation in social services
organizational level (ie organization of the provision of social services
type of service target group delivering logics)
regulatory and legislative level (lsquohow services are regulated organised
provided and financed the modalities of service provision the types of
relationships between external service providers and public authoritiesrsquo
EC 2006 p 8)
organizational level ndash connection and cooperation (partnership
networks governance)
professional level (social work methods and practices) -
users level
conceptual level and values
public policy level (policy framework programs and social policies)
financial and economic sustainability level (and scaling-diffusion-
transferability of innovation)
evaluative level and attention to quality (quality standards)
Crepaldi et al 2012 98-99
12
Table 1 Levels of response
Response Definition Example
New service New or improved
product of the scheme
or process
Personalised instead of
generic service
New form of delivery New or improved means
by which the outcome is
achieved
Self-help or social enterprise
instead of government agency
New form of
governance
New or improved way
the scheme or process is
managed and where it
draws authority from
Co-operative or user managed
instead of public service
New form of
resourcing
New or improved
financial human or
physical inputs to the
scheme or process
Grant-funded collectively
staffed organisation instead of
professionally managed
government agency
New way of
evaluation
New or improved
parameters by which
success is judged
User assessment of
effectiveness instead or
professional determined
criteria
It is important to note that innovation within a service is more challenging to define
and measure than innovation in the sense of a product (OECD 2005) while a
product is a tangible entity innovation within service provision can be a either a
product or a process and can occur at different levels of service provision and there
are a number of potential complexities which may inform the structure set out in
table 1
Phills et al (2008) for instance state that social innovation can be
ldquoa product production process or technology (much like innovation in
general) but it can also be a principle an idea a piece of legislation a social
movement an intervention or some combination of themrdquo (39)
In discussing public sector services Hartley (2005) emphasises that innovation is
ldquonot just a new idea but a new practicerdquo (27) and argues therefore that definitions
need to recognise practical impact For services this impact might be at one of
several levels
The organisation literature on innovation offers the initial distinction between
product and process innovation to which other types of innovation have been
added such as position and paradigm innovation (Tidd and Bessant 2009) For
social service oriented innovation further types are added
For example Hartley (2005) identifies the levels of product service process
position strategic governance and rhetorical innovations Hochgerner (2011) adds
social types of innovation to include roles relations norms and values
13
Osborne and Brown (2005) critique a number of typologies to classify innovation
from the management literature They point out that the dichotomy between
process and outcome makes them alternatives whereas an innovation and
particularly innovation in services can be both With services there is often not a
distinct separation between product and process with production delivery and
consumption of services often occurring simultaneously (OECD 2005)
32 Novelty
The next aspect is innovation is novelty In terms of novelty a three way
categorisation is proposed for INNOSERV new perspectives on old needs or
problems new practices for old needs or problems a new practice for a new need
The categorisation reflects the need for innovation to address both existing needs
and new needs Again there is much discussion in the literature about novelty in
relation to innovation Two points are addressed which can be summarised as
lsquowhat degreelevel of novelty equates to innovationrsquo and lsquonew to whomrsquo
The first distinction to be made is between different levels of innovation
ldquoThere are degrees of noveltyrunning from minor incremental
improvements right through to radical changes which transform the way we
think about and use them Sometimes these changes are common to a
particular sector or activity but sometimes they are so radical and far-
reaching that they change the basis of societyhelliprdquo (Tidd and Bessant 2009
27)
Tidd and Bessant usefully break down the incremental-radical continuum as lsquodoing
what we do betterrsquo lsquonew to the enterprisersquo and lsquonew to the worldrsquo (Tidd and
Bessant 2009 38)
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
14
While for some writers a change must be radical or pattern breaking in order to be
innovation it has been argued that within services innovation can be small
adjustments (Fuglsang 2010) Fuglsang in fact argues for a view of innovation in
public sector services as a process of building of skills and expanding routines (68)
The second part of the argument lsquonew to whomrsquo is whether innovation relates to
absolute first use A common to view of innovation is not just those elements
developed within an institution but also those adopted from others (for example
see OECD (2005) for business sector innovation Phills et al (2008) regarding social
innovation Hartley (2005) and Koch (2005) in relation to innovation in public
services) Phills et al (2008) for example state
ldquoAlthough innovations need not necessarily be original they must be new to
the user context or applicationrdquo (Phills et al 37)
Osborne and Brown (2005) purport that most studies consider newness as new to a
person organisation society or situation but not necessarily first use (2005 120)
The authors go on to argue that these are in fact different forms of innovation
differently termed as objective and subjective innovation (Kimberly 1981) or
intrinsic and extrinsic innovation (Downs and Mohr 1976)
Hartley (2005) expounds the dissemination and adaptation of innovation to other
contexts as particularly important for public sector services arguing that public
goals ldquocan be enhanced through collaborative arrangements to create share
transfer adapt and embed good practicerdquo (27) She terms this ldquorsquolateralrsquo innovationrdquo
(33) of good practice adoption and adaption
An example of this approach to defining innovation within social services is seen in
the UK Government policy document on innovation within the National Health
Service which states
ldquoinnovation is as much about applying an idea service or product in a new
context or in a new organisation as it is about creating something newrdquo
(Department of Health 2011 9)
15
33 Hallmarks of innovation
Within social service systems it is not sufficient to focus only on novelty as a
marker of innovation In addition the INNOSERV framework includes certain
hallmarks of innovation including assessment of context quality and sustainability
331 Contextual fit
Different innovative approaches need to fit within different service framework
contexts and need adaptation to those contexts Drawing further on the above
discussion of novelty INNOSERV employ this to mean new to a given (for example
national) context This will reflect the diversity of social service contexts within the
European Union Case studies will also consider transferability of an innovation
from one context to another
332 Improvement in quality
ldquoIn public servicesinnovation is justifiable only where it increases public
value in the quality efficiency or fitness for purpose of governance or
servicesrdquo (Hartley 2005 30)
It is commonly understood that innovation is about improvement as well as novelty
Hartley (2005) offers a model which sets out the possible relationships between
innovation and improvement These relationships are for organisations showing no
improvement and no innovation improvement but no innovation innovation but no
improvement innovation and improvement Important points to highlight from this
model relate to innovation but no improvement first that innovations may not
always lead to success and a level of failure is to be expected second that
innovation can lead to increased but undesired choice loss of performance due to
the process of learning and innovations that are ultimately of no value In terms of
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
16
what is to be measured as improvement Hartley maintains that beyond
improvements in service quality and fitness for purpose wider issues of public
value should be considered
The difficulties of measurement and evaluation of innovation in social services need
to be highlighted as the measures of success within a social project are difficult to
define (Bason 2010 Murray et al 2010) Improvement of social services can
include improved quality of life and access to economic and social opportunity
These issues may relate differently in the fields of health welfare and education
For instance quality of life within health may relate to physical health and mental
wellbeing at different stages of life within welfare issues such as equality of access
to housing cultural and community activities and employment are important
The INNOSERV case studies will include available information on the outcomes of
the innovative project although these will likely vary in terms of types of
measurement used by the projects
333 Sustainability
ldquoInnovation is not just about the originating idea but also the whole process
of the successful development implementation and spread of that idea into
widespread userdquo (Department of Health 2011)
It is recognised that change through innovation needs to be sustainable (Bereiter
2002) Achieving a sustainable innovation may involve streamlining of ideas and
altering them to work in everyday practice (Murray et al 2010 12) The
Normalisation Process Model offered by May and colleagues (May et al 2007 May
et al 2009) provides a theoretical explanation within the context of health care of
the processes through which interventions become embedded in practice and then
integrated and sustained
17
4 Drivers of innovation key societal changes
Innovation within social services needs to be relevant to key social challenges and
changes This relates to the purpose of social services in responding to pressing
social demands and societal needs It is therefore important for the INNOSERV
project to have an understanding of the key social challenges and changes driving
innovation to inform the lsquotheoretical trendsrsquo influencing future innovation
requirements As part of this work package we have therefore sought to identify
social challenges and changes which may act as driving forces of innovation and
shape the development of social service lsquoparadigmsrsquo and hence future social
change
Using a lsquoscenario planningrsquo methodology borrowed from management science can
help to test the limits to any paradigm and identify where new paradigm models
may be needed in the future This in turn should help to identify where future
research interests could be located to explore not just opportunities for innovation
within the current paradigm but also where socially driven change is creating new
opportunities (or indeed requirements) for social and social services innovation
Further these challenges feed into social service provision in terms of an imperative
to address new needs and level of need and issues of rising costs
The INNOSERV project undertook such a scenario planning process the outcomes
of which inform what follows here Using an extended literature study on future
social challenges in the European context a number of key factors promoting a
response from and requiring change in social services were identified Individual
partners made further analysis of the important social challenges within their own
national context The factors were synthesised into a table of key social challenges
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
18
(see appendix 3) separately for health welfare and education sectors although
there was much overlap in the challenges relating to each sector
Small groups involving two country based teams in each case took each social
challenge and considered how it may change and develop given current
understandings of the forces affecting change (some forces may promote change
and some may block change) These were considered against potential political
developments economic developments socialsociological change technological
development legallegislative changes and environmental factors with a focus on
volume nature depth timeframe and scale of importance in influencing future
developments in social services
This work informed extensive discussion at the INNOSERV June 2012 Consortium
meeting with regard to the impact of key future developments on innovation and
the choice of projects which should be used to test key innovation developments
and their relevance to future service development
Relevance is represented in the INNOSERV criteria framework by the lsquodriversrsquo box
which includes a number of examples The most significant social challenges and
changes which were identified by the Consortium as most pertinent to innovation in
social services are listed in table 2 (page 19) and are explored further in the
remainder of this section The selection of projects as case studies has included
analysis of which of these social challenges and changes are being addressed (see
Work Package 4 report Eurich and Strifler 2012)
41 Demographic change as a key societal change driving innovation in the
health and welfare social service sectors
Demographic change was identified as a driving force of innovation in both health
and welfare services in Europe Current demographic change is resulting in
increased numbers of people living longer into old age with a particular increase in
the numbers of people aged over 80 This is alongside a reduction in the numbers
of people of working age in part due to a declining birth rate Further socio-cultural
change is leading to concerns about levels of informal care for older people
While many people will want to live active lives in old age some will live with long
periods of ill health and will have complex care needs resulting from multiple co-
morbidities Most however prefer to live as independently as possible
Questions arise about the ability to meet these increasing care demands from
declining tax income bases In addition the specific needs of elderly patients with
dementia represent a unique challenge for nursing staff and the organisation of
nursing services Financing of the rising health care costs for public agencies or for
health insurance schemes requires sustainable solutions and structural reforms
Traditional models of hospital lsquoacutersquo care may not necessarily be appropriate for
meeting these health care needs
This all highlights the need to find alternative solutions to care needs including the
use of technology and reliance on informal carers Current responses which are
relevant to this driver include integration of health and social care services to
increase cost efficiencies use of technological solutions to enhance self care and
care at home and new paradigms such as Active Ageing
19
Table 2 Key social challenges and changes driving innovation
Social
challengesocial
change driving
innovation
Meaning Social service sector
in which driver is key
Demographic
change
Increase in numbers of over 65s Greatest
increase in over 80 age group Increase in
old age dependency ratio
Health sector
Welfare sector
Aspirations Rising expectations of citizens for better
quality of lifebetter care
Health sector
Education sector
Cross sector services of
education and health
Lifestyles Increase in certain diseases related to
obesity alcohol and drug consumption
and stress diabetes liver disease anxiety
and depression
Health sector
Cross sector services of
education and health
Technology Access to information new media
technology
Health sector
Continued
inequalities
Continued economic inequality
unemployment continued poverty
including child poverty continued
institutionalisation continued inequality for
people with disabilities ethnic minorities
gender inequalities impact of socio-
economic status on health outcomes
Welfare sector
Education sector
Cross sector services of
education and health
and welfare and
education
Independent living The approach now adopted by disabled
people to live as ordinary members of
society and in their chosen domestic
setting
Welfare sector
Social roles Changing families increase in single
households increase in single parent
families changing generational relations
(due to longer life expectancy) reduction in
extended families
Changing gender roles rising female
employment rates
Welfare sector
Education sector
Organisational
changes
Creating new organisational forms
application of more responsive
management processes performance
management culture
Welfare sector
Changing
management
styles
Application of more responsive
management processes
Education sector
Cross sector services of
education and health
20
42 Aspirations as a key societal change driving innovation for health and
for education service sectors
Citizen aspirations were identified as a key societal change acting as a driving force
for innovation within both the health and education sectors and across the
boundary of these sectors Across Europe citizens are expecting a better quality of
life including improved outcomes from health and care services and reduced
inequalities
In terms of the health service sector this both derives from and manifests itself in
a population which is more informed about health issues Consequently patients
wish to be more involved in decisions about their health and their health care
options and are more willing and able to participate in the management of their
condition There is less deference to the medical profession and greater willingness
to make demands on health services There are a growing number of patient led
movements which are challenging some medical traditions
This aspect is fundamental both to everyday practice and to the future development
trajectory for health care services While most health aspirations are limited by
current knowledge and medical skill as research and medical advance offer new
choices and opportunities but at greater costs there will be difficult questions for
political debate This could well result in very different more personalised and
lsquopatient managedrsquo models of health care support
In terms of the education service sector individualism and the connected
aspiration of lsquobeing involvedrsquo has been an increasing trend over the past years and
is expected to keep gaining importance This is not only reflected by agendas of
individually shaped curricula or learning arrangements in school but also by the
opening of the public (ie government funded) school system towards involvement
of the community (seniors in school corporate sponsoring external initiatives of
informal learning and personality formation etc) This is reflected in a similar way
in higher education (eg service learning) and adult education (lsquolearning regionsrsquo)
Across the boundary of health and education aspirations coupled with medical
advance lead to a desire for independence of disabled people and those with long
term conditions This highlights the need for health programs focussed on self
esteem
43 Lifestyles as a key societal challenge driving innovation in the health
service sector and also in the cross sector services of health and education
A key social challenge acting as a driving force for innovation for the health sector
and in the cross sector services of education and health is a recognised growth in
lsquolifestylersquo related conditions arising from unhealthy behaviours such as poor diet
alcohol consumption and smoking (although there is limited evidence of a decline
in smoking rates as its harmful effects are less well tolerated) Political investment
in public health is recognised as an important strategic ambition but often not
matched by financial resources Questions about personal responsibility are also
being asked with suggestions that people with poor health behaviours should not
be given the same priority to responsive health care services As other factors
impacting on health outcomes become more responsive to medical advance these
factors are growing in importance in their impact both on wider society and in
improving overall health outcomes
21
44 Technology as a key societal change driving innovation in the health
service sector
The growth in internet and web based technology is leading to an exponential
growth in access to information and new forms of communication More people
now use the internet as their primary health care information resource Web
lsquocommunitiesrsquo are linking and thus empowering people faced with similar health
challenges Telehealthcare solutions to on-going care needs are becoming more
widely available and are changing the patterns of demands for some health care
services Other new technologies for example in transport and in home assistance
devices are enabling greater independence for disabled people
As future generations use and expect more from access to information and
communication services health care services will have to respond to both the
demands and the opportunities created by such technology Technology can be
seen as both a driving force for innovation and as an enabler of change
45 Continued inequalities as a key societal challenge driving innovation in
welfare and education service sectors also in cross sector services of
education and health and welfare and education
Continued inequalities were identified as a key driving force for innovation within
both welfare and education sectors and in services which straddle the boundary
between education and health services and education and welfare services
Inequalities stem from issues of migration social originbackground
unemployment disability and gender and have been a source of the social
upheaval which has been seen in Europe in recent months
Within health education the link between socio-economic status and health is clear
with people from lower socio-economic groups experiencing poorer health and less
likely engaging in health promoting behaviours In the case of migrants health
messages need to be delivered in a culturally appropriate manner
46 Independent living as a key societal change driving innovation in the
welfare service sector
In terms of disability the emergence and spread of the independent living
philosophy has been a key change driving innovation in the welfare service sector
Typically innovation in this field involves new stakeholder roles with a much more
proactive role for service users in all stages of service provision design
implementation monitoring and fine tuning of services as well as a role in
coordination of different entitlementsservices andor administration and reporting
requirements The boundaries are being pushed further deeper and wider every
day Starting from persons with physical disabilities services are now promoting
active involvement of persons with severe mental disabilities a development that
was deemed impossible only 30 years ago
47 Social roles as a key societal change driving innovation for welfare and
for education service sectors
Changing social roles were identified as a key challenge driving innovation within
the welfare and education sectors These changes are within families and of the
family itself and include changing gender roles and changing family structures (eg
increase in single parent families increase in the numbers of older people living
alone) Families seem to be becoming a sphere of public or community interest
rather than an exclusively private one
Proper lsquosocializationrsquo of children is the key to building viable and sustainable
futures for individuals Early stage family intervention is necessary to prevent the
22
very emergence of conflicts lsquoExternalrsquo interventions often do not reach every day
interaction and thus the root causes of problems This is of significance for family
based projects as well as for care institutions and education providers
48 Organisational changes as a key societal change driving innovation in
welfare service sectors
The shifting of provision of services from the public sector into other sectors such
as independent profit making companies and social enterprises creates new
opportunities for innovation In addition there is an increasing move to provide
services locally in order to be more relevant and responsive and a move to
community based models of care
49 Changing management styles as a key innovation challenge for the
education service sector and in cross sector services of the health and
education sector
Connected to individualism as well as new social roles of individuals family
community and institutions management styles shaped by multi-stakeholder
involvement are gaining importance Community based models do not only increase
the complexity of players involved in the lsquovalue creationrsquo process but also the
enhancement of skill development and personality formation as well as the
fertilization of the educational landscape by innovative ideas expertise and
practices of diverse partners The latter fact also stimulates an increase in cross-
sectoral services (education health and social services) Simultaneously this
situation increases the necessity to spot choose and foster the lsquoinfluencesrsquo and
lsquocombinationsrsquo which realize the highest value through the assessment of social
impact
Increased emphasis is also being placed on illustrating and monitoring
performance Impact measurement and associated tools and practices gain
overarching importance
In terms of changing management styles within the health and education sector an
important aspect is the cooperation of different stakeholders and the involvement
of the community or userrsquos perspective Linked to increased user aspirations
people would like to take part in the development of programs and services With
their special knowledge of their condition for example they can contribute their
expertise within social services
23
5 Other key challenges driving innovation
Sociatal challenges and changes are of course only one driving force of innovation
In addition to these there are other meso and micro level factors which also drive
innovation These include research and development leading to new knowledge
professionally led innovation in response to users needs increasing costs of service
provision and demands for greater efficiency per se and specific political contexts
These other forces are included in the INNOSERV criteria framework in the
lsquochallengesrsquo box These factors are not a key focus for selection of projects for
INNOSERV as they are often very situation specific but will be noted in the case
studies where relevant The factors which prompt or trigger specific innovations
whether socially based or otherwise are not are not mutually exclusive (Bason
2010) and in there is a complex and interacting relationship between a variety of
factors for any given innovation lsquoinstancersquo In addition there are well documented
factors which act to inhibit the development of innovative responses (see Crepaldi
et al 201215)
This work package has sought to identify generic criteria and drivers but it must be
recognised that the dynamics of individual settings and local factors will impact on
the actual processes of adoption
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
24
6 Conclusions and next steps
This report has presented the framework which has been used within the INNOSERV
project to support the choice of innovative case studies and to assist in identifying
the innovation phenomena potential and processes important to future research in
this area The framework has been used to select projects as case studies (see Work
Package 4 report Eurich and Strifler 2012) The framework interlinks aspects of
innovation (novelty type context improvement sustainability) with analysis of
challenges and changes which are acting as driving forces of innovation in social
services As the project is future facing it is proposed that key social challenges
and changes are likely to inform the development of new change paradigms for the
delivery of social services across Europe The framework will inform further
development and testing of concepts through the next stages of the INNOSERVE
programme This process will result in descriptions for the key areas in which future
research on innovation in social services should be taken forward
25
7 Bibliography
Bason C (2010) Leading public sector innovation Co-creating for a better society
Bristol The Policy Press
Bereiter C (2002) Design research for sustained innovation Cognitive Studies
Bulletin of the Japanese Cognitive Society 9 321-327
Christensen CM and Overdorf M (2000) Meeting the Challenge of Disruptive
Change Harvard Business Review March-April
Clark M and Goodwin N (2010) Sustaining innovation in telehealth and telecare
WSDNA briefing paper London The Kings Fund
Crepaldi C De Rosa E And Pesce F (2012) Literature review on innovation in
social services in Europe (sectors of Health Education and Welfare
Services)INNOSERV Work Package 1 report
Department of Health (2011) Innovation Health and Wealth Accelerating Adoption
and Diffusion in the NHS London Department of Health
Eurich J and Strifler A (2012) European compared selection of innovative social
services INNOSERV Work Package 4 report
Fuglsang L (2010) Bricolage and invisible innovation in public service innovation
Journal of Innovation Economics 5 67-87
Greenhalgh T Robert G Macfarlane F Bate P Kyriakidou O (2004) Diffusion of
innovations in service organizations systematic review and recommendations
Milbank Quarterly 82581-629
Hartley J (2005) Innovation in Governance and Public Services Past and Present
Public Money and Management 25127-34
Koch P and Hauknes J (2005) On innovation in the Public Sector Publin report no
D20
Kuhn T (1962) The Structure of Scientific Revolutions Chicago The University of
Chicago Press
Lakatos I and Musgrave A (eds) (1970) Criticism and the growth of knowledge
London Cambridge University Press
May
C Finch T Mair F et al ( 2007) Understanding the implementation of
complex interventions in health care the normalization process model BMC Health
Services Research 2007 7148 doi1011861472-6963-7-148
May et al (2009) Implementing Embedding and Integrating Practices An Outline of
Normalization Process Theory Sociology 43 535-554
Murray R Caulier-Grice J and Mulgan G (2010) The Open Book of Social
Innovation London The Young Foundation
26
OECD (2005) Oslo manual Guidelines for collecting and interpreting innovation
data 3rd
edition
Oliver M (1990) The politics of disablement Basingstoke Macmillan Education Ltd
Osborne S (1998) Naming the Beast Defining and Classifying Service Innovations
in Social Policy Human Relations 51 9 1133-1154
Osborne S and Brown K (2005) Managing Change and Innovation in Public Service
Organizations London Routledge
Phills JA Deiglmeier K and Miller DT (2008) Rediscovering Social Innovation
Stamford Innovation Review 6 4 34-43
Sullivan M (1987) Sociology and Social Welfare London Allen and Unwin
Tidd J and Bessant J (2009) Managing Innovation Integrating Technological
Market and organizational Change 4th
edition Chichester John Wiley and Sons
UK Government Department of Health (2011) Innovation Health and Wealth
Accelerating adoption and diffusion in the NHS London Department of Health
Wolfensburger W (1975) The principle of normalisation in human services Toronto
National Institute on Mental Retardation
27
8 Appendices
Appendix 1 Summary of types and criteria of innovation used in Work Package
3 to identify practices
Identification of social service
Field(s) of service
Logic(s) of service
Self help or mutual aid logic Social care logic Multi-stakeholders logic Social
movements logic Combination
Activities of services delivered
Assistance for persons faced with personal challenges or crises (debt unemployment
drug addiction other) (Re)integration of persons into society (rehabilitation language
training for immigrants other) Services to the labour market (occupational training)
Social housing for disadvantaged groups Care (for the elderly children families )
Treatment and support of people with physical illnesses Treatment and support of
people with mental health problems Combination
Status of the provider organization
Public organization (governmental) Private organization ndash nonnot for profit Private
organization ndash profit Volunteer association Cooperative company or mutual company
Familyneighbourhood Civil society network Combination Other
Target group
Children Youngsters Elder people Unemployed people Poor people Immigrants
Disabled people People with chronic diseases ndash long-term health problems People with
acute or short term health problems No specific target group (eg territory-based social
services provision aiming at strengthen social ties) Combination Other
Size of the organization
Innovation
Type of innovation
New forms of organization resources hybridization new targeted actions new services
non-structural practices other
Innovative character
do the service practices appear to be something new in the field of social services
Origins of innovation
Supply side demand side broader operating factors
Impact on service performance
Effectiveness of service delivery
from user perspective cost effectivenesscapacity building sustainability of
innovation
Quality of provision
28
Socialization quality of life as judged by users and beneficiaries more inclusion
lower risk on exclusion participation of the user transition from institutional to
community based care
Potential wider effects
Promoting social and health equality sustainability new skills and jobs
increased social rights affordability of adequate and high quality health and long-
term care promotion of equality and non-discrimination equal access to adequate
provision
Transferability of innovations between national contexts
29
Appendix 2 levels of innovation identified within INNOSERV Work Package 2
literature review
Organizational level (policy organizational sectors)
New social services designed to face new needs or unmet needs
Search for new solutions to old needs new mechanisms or practices introduced in
preexisting
social services
to improve access to social services (ie more information increased
professionalism in
social work sector)
to guarantee entitlements (rights) for specific groups or minorities
to satisfy the demand for social services in a more complete and broad way
(holistic
approach)
to guarantee more participation and inclusion of citizens
New and increased Cross-Sectoral social services
Cross-Sectoral social services (ie teaching art to children while helping their mothers
for
job seeking and offering jobs for young artists)
Integrated care practices
Tearing down walls between sectors and the role of informal care
Sharing of knowledge
Better integration of Health and Social sector services
Territory based social services that contribute to the creation of training and job
opportunities for disadvantaged people
Solidarity-based social services
Social mediation for impaired and weakened people
Easy access to housing for poor families
New interfaces with clients
Logic(s) of service Self help or mutual aid logic Social care logic Multi-stakeholders
logic
Social movements logic
The development of the self-help sector
Actors New organizations (Cooperative society for social service provision ndashSCOP
Cooperative society as social enterprise with userrsquos involvement ndashSCIC)
New legal forms within structured public frameworks (Italy social cooperatives)
New provider organizations and existing organisations refashioned by new dynamics
New roles and relations among actors
New private organizations for profit and non-profit
Management style in the organization
Regulatory and legislative level
New architecture of the provision system
Socially responsible public contracts and social clauses (outsourcing)
Adherence to EU standards in transitional economies
Impact on institutional framework that shape innovation in social services
New arrangement between one or more government agencies andor external
organization
Organizational level ndash Connection and Cooperation (governance and partnership)
New networks and social movements established in order to design deliver and
finance
social services
Cooperation between sectors actors and different forms of provision
Cooperation between local actors
Increasing communication responsiveness
30
Utilizing connectivity and interdependencies
Modification of organizational systems (models of governance work organisation
number
of involved stakeholders in governance)
Public sector and local authorities as promoters of innovation and promoters of
crosssectoral
policy strategies
Third sector and user as promoters of innovation
Volunteer workers and initiatives launched by a group of citizens
Third sector and userrsquos engagement design (co-design and re-design services)
Joint decision process
Decision-making power not based on capital ownership
Employee and user driven innovation
Partnerships with users family carers and user organizations
Partnership between service users practitioners and academics
Community-based and participative health network in a local territory
Collaboration between public and volunteer organisations (NGOs) or between civil and
local
networks in collaboration with public organisations and social enterprises
New techniques for partnership building and functioning
Impact on social and power relations
Professional level (practitioners)
New practices in social work
Innovative tools (ie Theatre of the Oppressed) and the use of participated methods in
social
work (ie self-help group)
Networking
Individualised supports
New professional skills in social work
The use of informatics and new technologies in social work
Users
Participation and involvement of final users of services in designing delivering and
evaluating social services
Involvement of final users in promoting equality effectiveness and control and
adherence
to the needs of users
Conceptual Level (and value)
New models of society - Social goals participation user involvement community
benefit
New paradigms underlying a new social service concept or service delivery model (ie
new
inclusion paradigm active ageing)
Relationships and trust
Pursuing diversity
Better adjustment to usersrsquo needs more person centred support
More social services provision in less developed regions
New concept of accessibility of the service (ie for Roma families)
The concept of lsquoprogressive universalismrsquo
The Social Care Model
De-institutionalization and community care Improved home-based and community
services
Gender and diversity perspectives
Anti-discrimination and equality process
Increase of the level of recognition of social values objectives paradigms and goals
New models of interaction leading to social innovation processes
31
Public policy level (policy framework programs and social policies)
The new role of the system governance played by central (or local depending on
national
arrangements) government
Impact on public policies new public policy programme measure or intervention
Joint construction of a space for public action and redefinition of public governance
bodies
and methods
Innovative logics for public policies
Innovating the public sector
The new wide attention on anti stigma policies
E-government
Financial and economic sustainability level (and scaling-diffusion-transferability
of innovation)
New ways to overcome budgetary constraints
New approaches to acquire funding
The involvement of private investors
The introduction of special funds
The purchase of innovative practices by final users
Hybridization of resources (market redistribution and reciprocity resources)
New investment sources
Mobilising community resources taking full advantage of all endogenous resources
Improvement in efficiency and effectiveness
Financial and systemic sustainability Impact on the economy
Economic Environmental and Social Sustainability of Territory based social services
Financial tools necessary to territorial social initiatives and the way to unlock them
Capacity of spreading and diffusion
Evaluative level and attention for quality
Affordability availability and accessibility
New standards expected
New feedback loops from users and specialists
Social services of excellence as for quality efficiency and efficacy
New methods and creative tool-kits to strengthen and renew the quality of social care
services
Low-cost (for user) and high level quality of social services
Quality assurance moderation and accreditation mechanisms
New tools for monitoring social services - hearing all voices (users organizations
practioners staff family and friends)
Action research
Alternative economic and social indicators
Social impact and contribution of innovation in social services to social innovation and
social change ndash Assessment of innovation
Learning approach to evaluation ndash lsquoto learn from failuresrsquo
Developmental evaluation
Specifics for the Health sector
Disability from rehabilitation to integration and then to inclusion
Mental Health from segregation to inclusion and community care
HIV from segregationstigmatization to awareness campaigns for promoting self
protection
Innovation in the area of prevention of treatment and in the introduction of new
technologies
Emphasis on an inter-sectoral controlled and steered care in managed care models
replacement of the traditional insurance model
Integrated services
Technological progress
32
Specifics for the Education sector
Inclusive education
Inclusive education and training in collaboration with the civil society
Multicultural education
Integration of disciplines
Alternative schools non-regular schools and informal education
Link between formal and informal education
Community development based approaches
Connection between regular school and the system of social services
Experiential learning
Human rights education
Working lsquothrough relationshipsrsquo with children and young people
Problem based learning methodology
The lsquomedia educationrsquo The use of comics
ICT in schools
E-inclusion
Networks of schools
Improve supplement reinvent and transform learning
Sustained educational improvement
Learning Beyond the Classroom
Spreading a culture that values learning
More personalized approaches to learning
Using the web
Learning with and by not to and from
33
Appendix 3 analysis of social challenges and changes driving innovation
Welfare
Societal
change as
driving force
of innovation
in social
services
Meaning
description
Related
outcomesother
factors
Examples of innovative
responses
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
Empowerment self-
determination choice
The lsquoassertive userrsquo
Demand for more
individualised services of
better quality
Alternativecomplementary
providers
Personalisation
Co-production (new
userprofessional
relationships)
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demand on services
Potential for poor access
to services (from
communication
problems social
isolation)
Multiculturalism
Integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Declining female
caregiving
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
34
Increased demand for
services demand for
formal care
Continued
inequality
Continued
economic
inequality
unemployment
continued poverty
including child
poverty continued
institutionalisation
continued
inequality for
people with
disabilities ethnic
minorities gender
inequalities
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients
with complex
comorbidities increase
in certain diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing demand for
services Increasing
costsneed to make
limited resources go
further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
Decisions about value
marketization
Technological
development
Access to
information new
media technology
Facilitates self
determination increases
expectations and choice
population better
informed about
conditionsservicesright
s and less deferential
Users better able to
35
mobilise
Increased exclusion of
some groups with limited
access
New models of remote
care provision
Ability to exchange
information on quality
and experience
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Increasing costs
Decisions about value
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Organisational
change changing
management
styles
philosophies
Creating new
organisational
forms application
of more responsive
management
processes
performance
management
culture
Integration of
organisationsfunctions
new approaches to
lsquocommissioningrsquo of
organisationsservices
distortions caused by
lsquolocked inrsquo expenditures
(tertiary health care
residential care)
Decentralisation
deinstitutionalisation
marketization liberalisation
The lsquoenabling
statersquo Political
will fiscal space
Impact of financial
crisis competing
priorities for public
funds
Legacy of category-based
(not needs based) social
protection structural
transition
deindustrialisation
Health
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
EmpowermentSelf-
determination choice
Demand for more
individualised services of
better quality
Users better able to mobilise
Assertive lsquouserrsquo
knowledgeable patient
Alternativecomplimentary
providers
36
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demands on
services
Potential for poor access
to services (from
communication
problems social
isolation)
MulticulturalismTrained
health professionals
move to richer countries
integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Declining female
caregiving
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
Increased demand for
formal care services
Continued
inequalities
Unequal
distribution of
health risks and
health
outcomediseases
by socioeconomic
indicators
Unequal access to
care by social
status geography
gender and
ethnicity
Demographic Increase in
numbers of over
Increase in patients with
complex comorbidities
Increasing demand for care
Decisions about value Active
37
change 65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing costsneed to
make limited resources
go further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
ageing paradigm
Technological
development
Access to
information new
media technology
Self determination
expectations choice
population better
informed about
conditionsservicesright
s and less deferential
Ability to exchange
information on quality
and experience
New models of care provision
(eg telehealth care) new
health management systems
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Changing
management
stylesphilosophi
es
Application of
more responsive
management
processes
Decentralisation
deinstitutionalisation
marketization liberalisation
Lifestyle changes Increase in certain
diseases related to
obesity alcohol
and drug
Increasing
costsdemands for care
38
consumption and
stress diabetes
liver disease
anxiety and
depression
Education
Aspirations Rising expectations
by citizens for
better quality of
life
Self determination
choice consumerism
Education outside of formal
setting
Assertive user
Lifelong learningeducation
Migration Historical (post
colonial) migration
pan-EU migration
refugees
New needs for education
eg language and culture
Inequalities social
fragmentation
Social Roles Changing family
structure increase
in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
changing gender
roles rising
female
employment rates
Need to reconcile work
and family life
Parentingfamily skills
for vulnerable
parentsfamilies
Socialization of children
ndash social and emotional
deficits for children in
some environments
Work with families and
communities
Continued
inequalities
Inequality in
educational
accessattainment
by socioeconomic
status gender
people with
disabilities ethnic
minorities
Culture of failure
Promise to deliver social
mobility and economic
improvement
(Leadbeater and Wond
2010 pp 5-20)
Inclusive and multicultural
education
Differential support for
children from
lsquodisadvantagedrsquo
backgrounds
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients with
complex comorbidities
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
New group of older
39
learners
Technological
advance
Access to
information new
media technology
making learning
available in new
ways
Self determination
expectations choice
lsquoAssertive userrsquo
Increased exclusion of
some groups with limited
access
Changing
management
styles
philosophies
Community based models
Globalization Need to provide
educationtraining
which is suited to
modern knowledge
based global
economies
This report for the InnoServ project (grant agreement nr 290542) is supported
under the Socio-economic and Humanities Programme of FP7
Chris Hawker
Faculty of Health Sciences University of Southampton Building 67 University Road Highfield Campus Southampton SO17 1BJ
Tel +44 (0)23 8059 7968
Email CHawkersotonacuk
6
This report draws very much on the contribution of all the partners although
responsibility for writing it lies with the University of Southampton UK
The report begins with a brief review of the background theoretical concepts
relating to how innovation developments can be understood against knowledge and
practice development in social services It goes on to present the INNOSERV criteria
framework and to explore each of its components
2 Innovation service development and social change paradigm
development and service development
The assessment and understanding of innovation in social services takes place
within a number of organisational and cultural contexts
Our understanding of what is normal and what is new informed by
o Cultural assessments of what is safe and a reliance on lsquoconfirmedrsquo or
accepted knowledge
o The capacity to take risks and try out new ideas in practice or apply an
existing idea in a new situation creating new outcomes
The legal and political environments in which services are developed and
whether they promote adoption of new ideas and practices
In the area of social services these kinds of developments are embedded in a
number of sociologically derived factors including
Local social power structures
Economic capacity or constraint
Political ideologies
Professional ideologies and expertise
These variously integrate into a number of understood social lsquoparadigmsrsquo which
support or inhibit innovatory change Paradigms can support change by enabling
innovative developments to occur to improve the quality or functioning of social
systems within the prevailing paradigm These paradigms can also inhibit thinking
and action which might challenge the fundamental basis of the paradigm
A number of innovative developments can also accumulate in a system and which
collectively begin to challenge the basis for the paradigm itself These may support
the shift into a new social paradigm and inform influence and even radically alter
the way social systems work and develop
An example of this in practice is how the understanding and legal acceptance of
equality for people with disabilities particularly learning disabilities grew from a
number of innovative developments
lsquoNormalisationrsquo (Wolfensburger 1975) proposed that society should include
people with disabilities within the range of normal human existence
The de-institutionalisation of care which can for example be traced to
people with learning disabilities being supported to live in ordinary domestic
settings rather than specialist hospitals in British Columbia Canada
alongside other similar development in other settings
The lsquoindependent livingrsquo movement through which people with disabilities
argued that they should manage their social supports to meet their own
7
personal objectives rather than accept the standardised offerings of social
services organisations
The development of a lsquosocialrsquo rather than lsquomedicalrsquo model for how disability
should be described and understood
Each of these was an innovation some more challenging to the prevailing lsquocarersquo
paradigm than others During the last years of the 20th
century together they
accumulated to deliver a change in the fundamental paradigm informing most
European social systems so that what became an lsquoequalitiesrsquo based framework now
underlies the basis for these social systems (See for example Oliver 1990)
In practice of course these developments occurred simultaneously and in different
places The lsquoequalitiesrsquo arguments developed in the political domain at the same
time and informed and were informed by the practical innovations The
accumulation of the ideas to challenge legal frameworks and care systems occurred
in different ways in differing national contexts The pace of such changes taking
place in Eastern European countries now seeking to adopt these ideas in a single
often politically driven change illustrates an extreme form of lsquoinnovationrsquo adoption
This kind of development reflects processes of knowledge development identified
by Kuhn (1962) as lsquoscientific revolutionrsquo Kuhn noted that developments can occur
within what he calls lsquonormal sciencersquo until individual discoveries appear to challenge
the prevailing paradigm Some accommodations are often then made to the
paradigm but then once enough discoveries appear to challenge the basis of the
prevailing paradigm a new model has to be formed to accommodate the
discoveries lsquoNormalrsquo science can then resume within the new paradigm until this is
then in turn challenged The generation of a new paradigm also creates the
opportunity for new hypotheses which can be tested to form an expanded range of
ideas and knowledge These theories are complex and have developed a number of
critical channels for understanding how knowledge development is shaped or
limited For example some paradigm frameworks disable discovery by forcing a
rigid linguistically determined structure on knowledge development which disables
or actively prevents discovery (see for example Lakatos and Musgrave 1970)
This approach helps to understand how innovative developments in social services
relate to models of social change (see for example Sullivan 1987) Innovations can
occur within social systems but then accumulate to create or require a new social
model for social services The new social lsquomodelrsquo then generates a number of
innovations within the new framework so the equalities based social systems for
people with disabilities continue to generate for example new ideas in
employment for people with disabilities as a part of the lsquoindependent livingrsquo
concept
Innovation development therefore takes place in a dynamic environment Social
services innovations are informing social change and vice versa In order to identify
future innovation trends in social services it is important to understand how
changes in wider society will generate demands for and the development
space for innovation in social services
social services innovation will itself generate new opportunities for social
change
Using this kind of theoretical underpinning this report draws on the INNOSERV
innovation criteria developed in Work Package 1 and reviews the impact of key
societal changes to identify a set of relevant theoretical trends
8
3 Developing and defining innovation criteria
A review of the INNOSERV Work Packages 1 - 3 was undertaken at a meeting of
consortium members in June 2012 The INNOSERV Work Package 1 literature review
(Crepaldi et al 2012) identified a variety of definitions of innovation in services
service innovation and social innovation The literature review provided a first
working definition of innovation in social services shown in box 1 below and also
identified an extensive list of criteria for innovation which is included as appendix
2 This Work Package (2) contributes analysis of the key social challenges driving
innovation in social services Work Package 3 involved the collection of innovative
practice examples using some initial categorisation of innovation (see appendix 1)
BOX 1 INNOSERV first working definition of innovation in social services Innovation in social services can be defined as a type of social innovation process Innovation of social services is delivering services in another way as an answer to current and future challenges in society It mainly concerns (i) designing and implementing new social services to face new needs or unmet needs (ie types of services offered to face autism migrants with an irregular status violence against women) (ii) introducing new social services (or new mechanisms or practices) new interfaces with clients or new practices in social work in pre-existing social services Novelty improvements (effectiveness and efficiency) and sustainability are only first set of criteria to identify innovation in social services Values and the socio-cultural foundations of innovations in the social sphere should be considered Firstly in dealing with social services 1 respond lsquoto pressing social demands which are not addressed by the market and are directed to vulnerable groups in societyrsquo 2 address societal challenges at a level in which the boundary between social and economic blurs and societal challenges are directed towards society as a whole 3 generate systemic changes in changing attitudes and values strategies and policies organisational structures and processes delivery systems and services (Europe 2020 strategy Executive Summary EC) Social services innovations can be considered as ways to enhance processes and the outcome of social innovation Secondly situating social services within a social innovation framework means to focus on ways processes and mechanisms activated by social services that are able (a) to cope with more pressing social needs (b) to stimulate new solutions mobilizing peoples creativity and connecting people ideas and resources to a context of limited resources and rising costs (c) to be able to see social challenges also as opportunities (EC 2010 Murray Caulier-Grice Mulgan 2010) Crepaldi et al 2012 25-26
9
Following the review of these work packages the key elements of innovation for the
INNOSERV project were identified as
relevance to current and future societal challenges
type of innovation response
novelty
improvement
sustainability
context of innovation
These elements were incorporated into the INNOSERV criteria framework developed
to link these key innovation elements together The framework is shown in box 2
Box 2 The INNOSERV criteria framework linking aspects of innovation
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
10
The core of the framework focuses on the ways in which key innovations respond to
drivers and challenges It links distinct types of innovation criteria First there are
those criteria which together define innovation type of innovation or response
novelty and hallmarks of innovation including context improvement and
sustainability Linked to these are drivers or key societal challenges driving
change in social services and other challenges prompting innovation
The remaining sections of this report provide a rationale and explanation of each of
these five separate aspects that make up the framework along with definitions and
explanations of the individual elements within each to provide an analysis against
which the remaining developmental phases of the Innoserv programme can be
assessed
31 Innovation responses innovation in practice
The INNOSERV Work Package 1 literature review and collection of examples has
helped to explicate innovation operating at different lsquolevelsrsquo within service systems
The levels identified in the literature review are shown in summary form in Box 3
and are provided in full including examples in appendix 2
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
11
From this five types of response are detailed within the INNOSERV criteria
framework new service new form of delivery new form of governance new form of
resourcing and new way of evaluation The meaning of these five levels is provided
in table 1 and examples are given to illustrate this It should be noted that the
levels of response are not necessarily exclusive and a specific practice innovation
may fall into more than one category
Box 3 identified levels of innovation in social services
organizational level (ie organization of the provision of social services
type of service target group delivering logics)
regulatory and legislative level (lsquohow services are regulated organised
provided and financed the modalities of service provision the types of
relationships between external service providers and public authoritiesrsquo
EC 2006 p 8)
organizational level ndash connection and cooperation (partnership
networks governance)
professional level (social work methods and practices) -
users level
conceptual level and values
public policy level (policy framework programs and social policies)
financial and economic sustainability level (and scaling-diffusion-
transferability of innovation)
evaluative level and attention to quality (quality standards)
Crepaldi et al 2012 98-99
12
Table 1 Levels of response
Response Definition Example
New service New or improved
product of the scheme
or process
Personalised instead of
generic service
New form of delivery New or improved means
by which the outcome is
achieved
Self-help or social enterprise
instead of government agency
New form of
governance
New or improved way
the scheme or process is
managed and where it
draws authority from
Co-operative or user managed
instead of public service
New form of
resourcing
New or improved
financial human or
physical inputs to the
scheme or process
Grant-funded collectively
staffed organisation instead of
professionally managed
government agency
New way of
evaluation
New or improved
parameters by which
success is judged
User assessment of
effectiveness instead or
professional determined
criteria
It is important to note that innovation within a service is more challenging to define
and measure than innovation in the sense of a product (OECD 2005) while a
product is a tangible entity innovation within service provision can be a either a
product or a process and can occur at different levels of service provision and there
are a number of potential complexities which may inform the structure set out in
table 1
Phills et al (2008) for instance state that social innovation can be
ldquoa product production process or technology (much like innovation in
general) but it can also be a principle an idea a piece of legislation a social
movement an intervention or some combination of themrdquo (39)
In discussing public sector services Hartley (2005) emphasises that innovation is
ldquonot just a new idea but a new practicerdquo (27) and argues therefore that definitions
need to recognise practical impact For services this impact might be at one of
several levels
The organisation literature on innovation offers the initial distinction between
product and process innovation to which other types of innovation have been
added such as position and paradigm innovation (Tidd and Bessant 2009) For
social service oriented innovation further types are added
For example Hartley (2005) identifies the levels of product service process
position strategic governance and rhetorical innovations Hochgerner (2011) adds
social types of innovation to include roles relations norms and values
13
Osborne and Brown (2005) critique a number of typologies to classify innovation
from the management literature They point out that the dichotomy between
process and outcome makes them alternatives whereas an innovation and
particularly innovation in services can be both With services there is often not a
distinct separation between product and process with production delivery and
consumption of services often occurring simultaneously (OECD 2005)
32 Novelty
The next aspect is innovation is novelty In terms of novelty a three way
categorisation is proposed for INNOSERV new perspectives on old needs or
problems new practices for old needs or problems a new practice for a new need
The categorisation reflects the need for innovation to address both existing needs
and new needs Again there is much discussion in the literature about novelty in
relation to innovation Two points are addressed which can be summarised as
lsquowhat degreelevel of novelty equates to innovationrsquo and lsquonew to whomrsquo
The first distinction to be made is between different levels of innovation
ldquoThere are degrees of noveltyrunning from minor incremental
improvements right through to radical changes which transform the way we
think about and use them Sometimes these changes are common to a
particular sector or activity but sometimes they are so radical and far-
reaching that they change the basis of societyhelliprdquo (Tidd and Bessant 2009
27)
Tidd and Bessant usefully break down the incremental-radical continuum as lsquodoing
what we do betterrsquo lsquonew to the enterprisersquo and lsquonew to the worldrsquo (Tidd and
Bessant 2009 38)
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
14
While for some writers a change must be radical or pattern breaking in order to be
innovation it has been argued that within services innovation can be small
adjustments (Fuglsang 2010) Fuglsang in fact argues for a view of innovation in
public sector services as a process of building of skills and expanding routines (68)
The second part of the argument lsquonew to whomrsquo is whether innovation relates to
absolute first use A common to view of innovation is not just those elements
developed within an institution but also those adopted from others (for example
see OECD (2005) for business sector innovation Phills et al (2008) regarding social
innovation Hartley (2005) and Koch (2005) in relation to innovation in public
services) Phills et al (2008) for example state
ldquoAlthough innovations need not necessarily be original they must be new to
the user context or applicationrdquo (Phills et al 37)
Osborne and Brown (2005) purport that most studies consider newness as new to a
person organisation society or situation but not necessarily first use (2005 120)
The authors go on to argue that these are in fact different forms of innovation
differently termed as objective and subjective innovation (Kimberly 1981) or
intrinsic and extrinsic innovation (Downs and Mohr 1976)
Hartley (2005) expounds the dissemination and adaptation of innovation to other
contexts as particularly important for public sector services arguing that public
goals ldquocan be enhanced through collaborative arrangements to create share
transfer adapt and embed good practicerdquo (27) She terms this ldquorsquolateralrsquo innovationrdquo
(33) of good practice adoption and adaption
An example of this approach to defining innovation within social services is seen in
the UK Government policy document on innovation within the National Health
Service which states
ldquoinnovation is as much about applying an idea service or product in a new
context or in a new organisation as it is about creating something newrdquo
(Department of Health 2011 9)
15
33 Hallmarks of innovation
Within social service systems it is not sufficient to focus only on novelty as a
marker of innovation In addition the INNOSERV framework includes certain
hallmarks of innovation including assessment of context quality and sustainability
331 Contextual fit
Different innovative approaches need to fit within different service framework
contexts and need adaptation to those contexts Drawing further on the above
discussion of novelty INNOSERV employ this to mean new to a given (for example
national) context This will reflect the diversity of social service contexts within the
European Union Case studies will also consider transferability of an innovation
from one context to another
332 Improvement in quality
ldquoIn public servicesinnovation is justifiable only where it increases public
value in the quality efficiency or fitness for purpose of governance or
servicesrdquo (Hartley 2005 30)
It is commonly understood that innovation is about improvement as well as novelty
Hartley (2005) offers a model which sets out the possible relationships between
innovation and improvement These relationships are for organisations showing no
improvement and no innovation improvement but no innovation innovation but no
improvement innovation and improvement Important points to highlight from this
model relate to innovation but no improvement first that innovations may not
always lead to success and a level of failure is to be expected second that
innovation can lead to increased but undesired choice loss of performance due to
the process of learning and innovations that are ultimately of no value In terms of
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
16
what is to be measured as improvement Hartley maintains that beyond
improvements in service quality and fitness for purpose wider issues of public
value should be considered
The difficulties of measurement and evaluation of innovation in social services need
to be highlighted as the measures of success within a social project are difficult to
define (Bason 2010 Murray et al 2010) Improvement of social services can
include improved quality of life and access to economic and social opportunity
These issues may relate differently in the fields of health welfare and education
For instance quality of life within health may relate to physical health and mental
wellbeing at different stages of life within welfare issues such as equality of access
to housing cultural and community activities and employment are important
The INNOSERV case studies will include available information on the outcomes of
the innovative project although these will likely vary in terms of types of
measurement used by the projects
333 Sustainability
ldquoInnovation is not just about the originating idea but also the whole process
of the successful development implementation and spread of that idea into
widespread userdquo (Department of Health 2011)
It is recognised that change through innovation needs to be sustainable (Bereiter
2002) Achieving a sustainable innovation may involve streamlining of ideas and
altering them to work in everyday practice (Murray et al 2010 12) The
Normalisation Process Model offered by May and colleagues (May et al 2007 May
et al 2009) provides a theoretical explanation within the context of health care of
the processes through which interventions become embedded in practice and then
integrated and sustained
17
4 Drivers of innovation key societal changes
Innovation within social services needs to be relevant to key social challenges and
changes This relates to the purpose of social services in responding to pressing
social demands and societal needs It is therefore important for the INNOSERV
project to have an understanding of the key social challenges and changes driving
innovation to inform the lsquotheoretical trendsrsquo influencing future innovation
requirements As part of this work package we have therefore sought to identify
social challenges and changes which may act as driving forces of innovation and
shape the development of social service lsquoparadigmsrsquo and hence future social
change
Using a lsquoscenario planningrsquo methodology borrowed from management science can
help to test the limits to any paradigm and identify where new paradigm models
may be needed in the future This in turn should help to identify where future
research interests could be located to explore not just opportunities for innovation
within the current paradigm but also where socially driven change is creating new
opportunities (or indeed requirements) for social and social services innovation
Further these challenges feed into social service provision in terms of an imperative
to address new needs and level of need and issues of rising costs
The INNOSERV project undertook such a scenario planning process the outcomes
of which inform what follows here Using an extended literature study on future
social challenges in the European context a number of key factors promoting a
response from and requiring change in social services were identified Individual
partners made further analysis of the important social challenges within their own
national context The factors were synthesised into a table of key social challenges
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
18
(see appendix 3) separately for health welfare and education sectors although
there was much overlap in the challenges relating to each sector
Small groups involving two country based teams in each case took each social
challenge and considered how it may change and develop given current
understandings of the forces affecting change (some forces may promote change
and some may block change) These were considered against potential political
developments economic developments socialsociological change technological
development legallegislative changes and environmental factors with a focus on
volume nature depth timeframe and scale of importance in influencing future
developments in social services
This work informed extensive discussion at the INNOSERV June 2012 Consortium
meeting with regard to the impact of key future developments on innovation and
the choice of projects which should be used to test key innovation developments
and their relevance to future service development
Relevance is represented in the INNOSERV criteria framework by the lsquodriversrsquo box
which includes a number of examples The most significant social challenges and
changes which were identified by the Consortium as most pertinent to innovation in
social services are listed in table 2 (page 19) and are explored further in the
remainder of this section The selection of projects as case studies has included
analysis of which of these social challenges and changes are being addressed (see
Work Package 4 report Eurich and Strifler 2012)
41 Demographic change as a key societal change driving innovation in the
health and welfare social service sectors
Demographic change was identified as a driving force of innovation in both health
and welfare services in Europe Current demographic change is resulting in
increased numbers of people living longer into old age with a particular increase in
the numbers of people aged over 80 This is alongside a reduction in the numbers
of people of working age in part due to a declining birth rate Further socio-cultural
change is leading to concerns about levels of informal care for older people
While many people will want to live active lives in old age some will live with long
periods of ill health and will have complex care needs resulting from multiple co-
morbidities Most however prefer to live as independently as possible
Questions arise about the ability to meet these increasing care demands from
declining tax income bases In addition the specific needs of elderly patients with
dementia represent a unique challenge for nursing staff and the organisation of
nursing services Financing of the rising health care costs for public agencies or for
health insurance schemes requires sustainable solutions and structural reforms
Traditional models of hospital lsquoacutersquo care may not necessarily be appropriate for
meeting these health care needs
This all highlights the need to find alternative solutions to care needs including the
use of technology and reliance on informal carers Current responses which are
relevant to this driver include integration of health and social care services to
increase cost efficiencies use of technological solutions to enhance self care and
care at home and new paradigms such as Active Ageing
19
Table 2 Key social challenges and changes driving innovation
Social
challengesocial
change driving
innovation
Meaning Social service sector
in which driver is key
Demographic
change
Increase in numbers of over 65s Greatest
increase in over 80 age group Increase in
old age dependency ratio
Health sector
Welfare sector
Aspirations Rising expectations of citizens for better
quality of lifebetter care
Health sector
Education sector
Cross sector services of
education and health
Lifestyles Increase in certain diseases related to
obesity alcohol and drug consumption
and stress diabetes liver disease anxiety
and depression
Health sector
Cross sector services of
education and health
Technology Access to information new media
technology
Health sector
Continued
inequalities
Continued economic inequality
unemployment continued poverty
including child poverty continued
institutionalisation continued inequality for
people with disabilities ethnic minorities
gender inequalities impact of socio-
economic status on health outcomes
Welfare sector
Education sector
Cross sector services of
education and health
and welfare and
education
Independent living The approach now adopted by disabled
people to live as ordinary members of
society and in their chosen domestic
setting
Welfare sector
Social roles Changing families increase in single
households increase in single parent
families changing generational relations
(due to longer life expectancy) reduction in
extended families
Changing gender roles rising female
employment rates
Welfare sector
Education sector
Organisational
changes
Creating new organisational forms
application of more responsive
management processes performance
management culture
Welfare sector
Changing
management
styles
Application of more responsive
management processes
Education sector
Cross sector services of
education and health
20
42 Aspirations as a key societal change driving innovation for health and
for education service sectors
Citizen aspirations were identified as a key societal change acting as a driving force
for innovation within both the health and education sectors and across the
boundary of these sectors Across Europe citizens are expecting a better quality of
life including improved outcomes from health and care services and reduced
inequalities
In terms of the health service sector this both derives from and manifests itself in
a population which is more informed about health issues Consequently patients
wish to be more involved in decisions about their health and their health care
options and are more willing and able to participate in the management of their
condition There is less deference to the medical profession and greater willingness
to make demands on health services There are a growing number of patient led
movements which are challenging some medical traditions
This aspect is fundamental both to everyday practice and to the future development
trajectory for health care services While most health aspirations are limited by
current knowledge and medical skill as research and medical advance offer new
choices and opportunities but at greater costs there will be difficult questions for
political debate This could well result in very different more personalised and
lsquopatient managedrsquo models of health care support
In terms of the education service sector individualism and the connected
aspiration of lsquobeing involvedrsquo has been an increasing trend over the past years and
is expected to keep gaining importance This is not only reflected by agendas of
individually shaped curricula or learning arrangements in school but also by the
opening of the public (ie government funded) school system towards involvement
of the community (seniors in school corporate sponsoring external initiatives of
informal learning and personality formation etc) This is reflected in a similar way
in higher education (eg service learning) and adult education (lsquolearning regionsrsquo)
Across the boundary of health and education aspirations coupled with medical
advance lead to a desire for independence of disabled people and those with long
term conditions This highlights the need for health programs focussed on self
esteem
43 Lifestyles as a key societal challenge driving innovation in the health
service sector and also in the cross sector services of health and education
A key social challenge acting as a driving force for innovation for the health sector
and in the cross sector services of education and health is a recognised growth in
lsquolifestylersquo related conditions arising from unhealthy behaviours such as poor diet
alcohol consumption and smoking (although there is limited evidence of a decline
in smoking rates as its harmful effects are less well tolerated) Political investment
in public health is recognised as an important strategic ambition but often not
matched by financial resources Questions about personal responsibility are also
being asked with suggestions that people with poor health behaviours should not
be given the same priority to responsive health care services As other factors
impacting on health outcomes become more responsive to medical advance these
factors are growing in importance in their impact both on wider society and in
improving overall health outcomes
21
44 Technology as a key societal change driving innovation in the health
service sector
The growth in internet and web based technology is leading to an exponential
growth in access to information and new forms of communication More people
now use the internet as their primary health care information resource Web
lsquocommunitiesrsquo are linking and thus empowering people faced with similar health
challenges Telehealthcare solutions to on-going care needs are becoming more
widely available and are changing the patterns of demands for some health care
services Other new technologies for example in transport and in home assistance
devices are enabling greater independence for disabled people
As future generations use and expect more from access to information and
communication services health care services will have to respond to both the
demands and the opportunities created by such technology Technology can be
seen as both a driving force for innovation and as an enabler of change
45 Continued inequalities as a key societal challenge driving innovation in
welfare and education service sectors also in cross sector services of
education and health and welfare and education
Continued inequalities were identified as a key driving force for innovation within
both welfare and education sectors and in services which straddle the boundary
between education and health services and education and welfare services
Inequalities stem from issues of migration social originbackground
unemployment disability and gender and have been a source of the social
upheaval which has been seen in Europe in recent months
Within health education the link between socio-economic status and health is clear
with people from lower socio-economic groups experiencing poorer health and less
likely engaging in health promoting behaviours In the case of migrants health
messages need to be delivered in a culturally appropriate manner
46 Independent living as a key societal change driving innovation in the
welfare service sector
In terms of disability the emergence and spread of the independent living
philosophy has been a key change driving innovation in the welfare service sector
Typically innovation in this field involves new stakeholder roles with a much more
proactive role for service users in all stages of service provision design
implementation monitoring and fine tuning of services as well as a role in
coordination of different entitlementsservices andor administration and reporting
requirements The boundaries are being pushed further deeper and wider every
day Starting from persons with physical disabilities services are now promoting
active involvement of persons with severe mental disabilities a development that
was deemed impossible only 30 years ago
47 Social roles as a key societal change driving innovation for welfare and
for education service sectors
Changing social roles were identified as a key challenge driving innovation within
the welfare and education sectors These changes are within families and of the
family itself and include changing gender roles and changing family structures (eg
increase in single parent families increase in the numbers of older people living
alone) Families seem to be becoming a sphere of public or community interest
rather than an exclusively private one
Proper lsquosocializationrsquo of children is the key to building viable and sustainable
futures for individuals Early stage family intervention is necessary to prevent the
22
very emergence of conflicts lsquoExternalrsquo interventions often do not reach every day
interaction and thus the root causes of problems This is of significance for family
based projects as well as for care institutions and education providers
48 Organisational changes as a key societal change driving innovation in
welfare service sectors
The shifting of provision of services from the public sector into other sectors such
as independent profit making companies and social enterprises creates new
opportunities for innovation In addition there is an increasing move to provide
services locally in order to be more relevant and responsive and a move to
community based models of care
49 Changing management styles as a key innovation challenge for the
education service sector and in cross sector services of the health and
education sector
Connected to individualism as well as new social roles of individuals family
community and institutions management styles shaped by multi-stakeholder
involvement are gaining importance Community based models do not only increase
the complexity of players involved in the lsquovalue creationrsquo process but also the
enhancement of skill development and personality formation as well as the
fertilization of the educational landscape by innovative ideas expertise and
practices of diverse partners The latter fact also stimulates an increase in cross-
sectoral services (education health and social services) Simultaneously this
situation increases the necessity to spot choose and foster the lsquoinfluencesrsquo and
lsquocombinationsrsquo which realize the highest value through the assessment of social
impact
Increased emphasis is also being placed on illustrating and monitoring
performance Impact measurement and associated tools and practices gain
overarching importance
In terms of changing management styles within the health and education sector an
important aspect is the cooperation of different stakeholders and the involvement
of the community or userrsquos perspective Linked to increased user aspirations
people would like to take part in the development of programs and services With
their special knowledge of their condition for example they can contribute their
expertise within social services
23
5 Other key challenges driving innovation
Sociatal challenges and changes are of course only one driving force of innovation
In addition to these there are other meso and micro level factors which also drive
innovation These include research and development leading to new knowledge
professionally led innovation in response to users needs increasing costs of service
provision and demands for greater efficiency per se and specific political contexts
These other forces are included in the INNOSERV criteria framework in the
lsquochallengesrsquo box These factors are not a key focus for selection of projects for
INNOSERV as they are often very situation specific but will be noted in the case
studies where relevant The factors which prompt or trigger specific innovations
whether socially based or otherwise are not are not mutually exclusive (Bason
2010) and in there is a complex and interacting relationship between a variety of
factors for any given innovation lsquoinstancersquo In addition there are well documented
factors which act to inhibit the development of innovative responses (see Crepaldi
et al 201215)
This work package has sought to identify generic criteria and drivers but it must be
recognised that the dynamics of individual settings and local factors will impact on
the actual processes of adoption
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
24
6 Conclusions and next steps
This report has presented the framework which has been used within the INNOSERV
project to support the choice of innovative case studies and to assist in identifying
the innovation phenomena potential and processes important to future research in
this area The framework has been used to select projects as case studies (see Work
Package 4 report Eurich and Strifler 2012) The framework interlinks aspects of
innovation (novelty type context improvement sustainability) with analysis of
challenges and changes which are acting as driving forces of innovation in social
services As the project is future facing it is proposed that key social challenges
and changes are likely to inform the development of new change paradigms for the
delivery of social services across Europe The framework will inform further
development and testing of concepts through the next stages of the INNOSERVE
programme This process will result in descriptions for the key areas in which future
research on innovation in social services should be taken forward
25
7 Bibliography
Bason C (2010) Leading public sector innovation Co-creating for a better society
Bristol The Policy Press
Bereiter C (2002) Design research for sustained innovation Cognitive Studies
Bulletin of the Japanese Cognitive Society 9 321-327
Christensen CM and Overdorf M (2000) Meeting the Challenge of Disruptive
Change Harvard Business Review March-April
Clark M and Goodwin N (2010) Sustaining innovation in telehealth and telecare
WSDNA briefing paper London The Kings Fund
Crepaldi C De Rosa E And Pesce F (2012) Literature review on innovation in
social services in Europe (sectors of Health Education and Welfare
Services)INNOSERV Work Package 1 report
Department of Health (2011) Innovation Health and Wealth Accelerating Adoption
and Diffusion in the NHS London Department of Health
Eurich J and Strifler A (2012) European compared selection of innovative social
services INNOSERV Work Package 4 report
Fuglsang L (2010) Bricolage and invisible innovation in public service innovation
Journal of Innovation Economics 5 67-87
Greenhalgh T Robert G Macfarlane F Bate P Kyriakidou O (2004) Diffusion of
innovations in service organizations systematic review and recommendations
Milbank Quarterly 82581-629
Hartley J (2005) Innovation in Governance and Public Services Past and Present
Public Money and Management 25127-34
Koch P and Hauknes J (2005) On innovation in the Public Sector Publin report no
D20
Kuhn T (1962) The Structure of Scientific Revolutions Chicago The University of
Chicago Press
Lakatos I and Musgrave A (eds) (1970) Criticism and the growth of knowledge
London Cambridge University Press
May
C Finch T Mair F et al ( 2007) Understanding the implementation of
complex interventions in health care the normalization process model BMC Health
Services Research 2007 7148 doi1011861472-6963-7-148
May et al (2009) Implementing Embedding and Integrating Practices An Outline of
Normalization Process Theory Sociology 43 535-554
Murray R Caulier-Grice J and Mulgan G (2010) The Open Book of Social
Innovation London The Young Foundation
26
OECD (2005) Oslo manual Guidelines for collecting and interpreting innovation
data 3rd
edition
Oliver M (1990) The politics of disablement Basingstoke Macmillan Education Ltd
Osborne S (1998) Naming the Beast Defining and Classifying Service Innovations
in Social Policy Human Relations 51 9 1133-1154
Osborne S and Brown K (2005) Managing Change and Innovation in Public Service
Organizations London Routledge
Phills JA Deiglmeier K and Miller DT (2008) Rediscovering Social Innovation
Stamford Innovation Review 6 4 34-43
Sullivan M (1987) Sociology and Social Welfare London Allen and Unwin
Tidd J and Bessant J (2009) Managing Innovation Integrating Technological
Market and organizational Change 4th
edition Chichester John Wiley and Sons
UK Government Department of Health (2011) Innovation Health and Wealth
Accelerating adoption and diffusion in the NHS London Department of Health
Wolfensburger W (1975) The principle of normalisation in human services Toronto
National Institute on Mental Retardation
27
8 Appendices
Appendix 1 Summary of types and criteria of innovation used in Work Package
3 to identify practices
Identification of social service
Field(s) of service
Logic(s) of service
Self help or mutual aid logic Social care logic Multi-stakeholders logic Social
movements logic Combination
Activities of services delivered
Assistance for persons faced with personal challenges or crises (debt unemployment
drug addiction other) (Re)integration of persons into society (rehabilitation language
training for immigrants other) Services to the labour market (occupational training)
Social housing for disadvantaged groups Care (for the elderly children families )
Treatment and support of people with physical illnesses Treatment and support of
people with mental health problems Combination
Status of the provider organization
Public organization (governmental) Private organization ndash nonnot for profit Private
organization ndash profit Volunteer association Cooperative company or mutual company
Familyneighbourhood Civil society network Combination Other
Target group
Children Youngsters Elder people Unemployed people Poor people Immigrants
Disabled people People with chronic diseases ndash long-term health problems People with
acute or short term health problems No specific target group (eg territory-based social
services provision aiming at strengthen social ties) Combination Other
Size of the organization
Innovation
Type of innovation
New forms of organization resources hybridization new targeted actions new services
non-structural practices other
Innovative character
do the service practices appear to be something new in the field of social services
Origins of innovation
Supply side demand side broader operating factors
Impact on service performance
Effectiveness of service delivery
from user perspective cost effectivenesscapacity building sustainability of
innovation
Quality of provision
28
Socialization quality of life as judged by users and beneficiaries more inclusion
lower risk on exclusion participation of the user transition from institutional to
community based care
Potential wider effects
Promoting social and health equality sustainability new skills and jobs
increased social rights affordability of adequate and high quality health and long-
term care promotion of equality and non-discrimination equal access to adequate
provision
Transferability of innovations between national contexts
29
Appendix 2 levels of innovation identified within INNOSERV Work Package 2
literature review
Organizational level (policy organizational sectors)
New social services designed to face new needs or unmet needs
Search for new solutions to old needs new mechanisms or practices introduced in
preexisting
social services
to improve access to social services (ie more information increased
professionalism in
social work sector)
to guarantee entitlements (rights) for specific groups or minorities
to satisfy the demand for social services in a more complete and broad way
(holistic
approach)
to guarantee more participation and inclusion of citizens
New and increased Cross-Sectoral social services
Cross-Sectoral social services (ie teaching art to children while helping their mothers
for
job seeking and offering jobs for young artists)
Integrated care practices
Tearing down walls between sectors and the role of informal care
Sharing of knowledge
Better integration of Health and Social sector services
Territory based social services that contribute to the creation of training and job
opportunities for disadvantaged people
Solidarity-based social services
Social mediation for impaired and weakened people
Easy access to housing for poor families
New interfaces with clients
Logic(s) of service Self help or mutual aid logic Social care logic Multi-stakeholders
logic
Social movements logic
The development of the self-help sector
Actors New organizations (Cooperative society for social service provision ndashSCOP
Cooperative society as social enterprise with userrsquos involvement ndashSCIC)
New legal forms within structured public frameworks (Italy social cooperatives)
New provider organizations and existing organisations refashioned by new dynamics
New roles and relations among actors
New private organizations for profit and non-profit
Management style in the organization
Regulatory and legislative level
New architecture of the provision system
Socially responsible public contracts and social clauses (outsourcing)
Adherence to EU standards in transitional economies
Impact on institutional framework that shape innovation in social services
New arrangement between one or more government agencies andor external
organization
Organizational level ndash Connection and Cooperation (governance and partnership)
New networks and social movements established in order to design deliver and
finance
social services
Cooperation between sectors actors and different forms of provision
Cooperation between local actors
Increasing communication responsiveness
30
Utilizing connectivity and interdependencies
Modification of organizational systems (models of governance work organisation
number
of involved stakeholders in governance)
Public sector and local authorities as promoters of innovation and promoters of
crosssectoral
policy strategies
Third sector and user as promoters of innovation
Volunteer workers and initiatives launched by a group of citizens
Third sector and userrsquos engagement design (co-design and re-design services)
Joint decision process
Decision-making power not based on capital ownership
Employee and user driven innovation
Partnerships with users family carers and user organizations
Partnership between service users practitioners and academics
Community-based and participative health network in a local territory
Collaboration between public and volunteer organisations (NGOs) or between civil and
local
networks in collaboration with public organisations and social enterprises
New techniques for partnership building and functioning
Impact on social and power relations
Professional level (practitioners)
New practices in social work
Innovative tools (ie Theatre of the Oppressed) and the use of participated methods in
social
work (ie self-help group)
Networking
Individualised supports
New professional skills in social work
The use of informatics and new technologies in social work
Users
Participation and involvement of final users of services in designing delivering and
evaluating social services
Involvement of final users in promoting equality effectiveness and control and
adherence
to the needs of users
Conceptual Level (and value)
New models of society - Social goals participation user involvement community
benefit
New paradigms underlying a new social service concept or service delivery model (ie
new
inclusion paradigm active ageing)
Relationships and trust
Pursuing diversity
Better adjustment to usersrsquo needs more person centred support
More social services provision in less developed regions
New concept of accessibility of the service (ie for Roma families)
The concept of lsquoprogressive universalismrsquo
The Social Care Model
De-institutionalization and community care Improved home-based and community
services
Gender and diversity perspectives
Anti-discrimination and equality process
Increase of the level of recognition of social values objectives paradigms and goals
New models of interaction leading to social innovation processes
31
Public policy level (policy framework programs and social policies)
The new role of the system governance played by central (or local depending on
national
arrangements) government
Impact on public policies new public policy programme measure or intervention
Joint construction of a space for public action and redefinition of public governance
bodies
and methods
Innovative logics for public policies
Innovating the public sector
The new wide attention on anti stigma policies
E-government
Financial and economic sustainability level (and scaling-diffusion-transferability
of innovation)
New ways to overcome budgetary constraints
New approaches to acquire funding
The involvement of private investors
The introduction of special funds
The purchase of innovative practices by final users
Hybridization of resources (market redistribution and reciprocity resources)
New investment sources
Mobilising community resources taking full advantage of all endogenous resources
Improvement in efficiency and effectiveness
Financial and systemic sustainability Impact on the economy
Economic Environmental and Social Sustainability of Territory based social services
Financial tools necessary to territorial social initiatives and the way to unlock them
Capacity of spreading and diffusion
Evaluative level and attention for quality
Affordability availability and accessibility
New standards expected
New feedback loops from users and specialists
Social services of excellence as for quality efficiency and efficacy
New methods and creative tool-kits to strengthen and renew the quality of social care
services
Low-cost (for user) and high level quality of social services
Quality assurance moderation and accreditation mechanisms
New tools for monitoring social services - hearing all voices (users organizations
practioners staff family and friends)
Action research
Alternative economic and social indicators
Social impact and contribution of innovation in social services to social innovation and
social change ndash Assessment of innovation
Learning approach to evaluation ndash lsquoto learn from failuresrsquo
Developmental evaluation
Specifics for the Health sector
Disability from rehabilitation to integration and then to inclusion
Mental Health from segregation to inclusion and community care
HIV from segregationstigmatization to awareness campaigns for promoting self
protection
Innovation in the area of prevention of treatment and in the introduction of new
technologies
Emphasis on an inter-sectoral controlled and steered care in managed care models
replacement of the traditional insurance model
Integrated services
Technological progress
32
Specifics for the Education sector
Inclusive education
Inclusive education and training in collaboration with the civil society
Multicultural education
Integration of disciplines
Alternative schools non-regular schools and informal education
Link between formal and informal education
Community development based approaches
Connection between regular school and the system of social services
Experiential learning
Human rights education
Working lsquothrough relationshipsrsquo with children and young people
Problem based learning methodology
The lsquomedia educationrsquo The use of comics
ICT in schools
E-inclusion
Networks of schools
Improve supplement reinvent and transform learning
Sustained educational improvement
Learning Beyond the Classroom
Spreading a culture that values learning
More personalized approaches to learning
Using the web
Learning with and by not to and from
33
Appendix 3 analysis of social challenges and changes driving innovation
Welfare
Societal
change as
driving force
of innovation
in social
services
Meaning
description
Related
outcomesother
factors
Examples of innovative
responses
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
Empowerment self-
determination choice
The lsquoassertive userrsquo
Demand for more
individualised services of
better quality
Alternativecomplementary
providers
Personalisation
Co-production (new
userprofessional
relationships)
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demand on services
Potential for poor access
to services (from
communication
problems social
isolation)
Multiculturalism
Integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Declining female
caregiving
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
34
Increased demand for
services demand for
formal care
Continued
inequality
Continued
economic
inequality
unemployment
continued poverty
including child
poverty continued
institutionalisation
continued
inequality for
people with
disabilities ethnic
minorities gender
inequalities
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients
with complex
comorbidities increase
in certain diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing demand for
services Increasing
costsneed to make
limited resources go
further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
Decisions about value
marketization
Technological
development
Access to
information new
media technology
Facilitates self
determination increases
expectations and choice
population better
informed about
conditionsservicesright
s and less deferential
Users better able to
35
mobilise
Increased exclusion of
some groups with limited
access
New models of remote
care provision
Ability to exchange
information on quality
and experience
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Increasing costs
Decisions about value
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Organisational
change changing
management
styles
philosophies
Creating new
organisational
forms application
of more responsive
management
processes
performance
management
culture
Integration of
organisationsfunctions
new approaches to
lsquocommissioningrsquo of
organisationsservices
distortions caused by
lsquolocked inrsquo expenditures
(tertiary health care
residential care)
Decentralisation
deinstitutionalisation
marketization liberalisation
The lsquoenabling
statersquo Political
will fiscal space
Impact of financial
crisis competing
priorities for public
funds
Legacy of category-based
(not needs based) social
protection structural
transition
deindustrialisation
Health
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
EmpowermentSelf-
determination choice
Demand for more
individualised services of
better quality
Users better able to mobilise
Assertive lsquouserrsquo
knowledgeable patient
Alternativecomplimentary
providers
36
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demands on
services
Potential for poor access
to services (from
communication
problems social
isolation)
MulticulturalismTrained
health professionals
move to richer countries
integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Declining female
caregiving
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
Increased demand for
formal care services
Continued
inequalities
Unequal
distribution of
health risks and
health
outcomediseases
by socioeconomic
indicators
Unequal access to
care by social
status geography
gender and
ethnicity
Demographic Increase in
numbers of over
Increase in patients with
complex comorbidities
Increasing demand for care
Decisions about value Active
37
change 65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing costsneed to
make limited resources
go further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
ageing paradigm
Technological
development
Access to
information new
media technology
Self determination
expectations choice
population better
informed about
conditionsservicesright
s and less deferential
Ability to exchange
information on quality
and experience
New models of care provision
(eg telehealth care) new
health management systems
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Changing
management
stylesphilosophi
es
Application of
more responsive
management
processes
Decentralisation
deinstitutionalisation
marketization liberalisation
Lifestyle changes Increase in certain
diseases related to
obesity alcohol
and drug
Increasing
costsdemands for care
38
consumption and
stress diabetes
liver disease
anxiety and
depression
Education
Aspirations Rising expectations
by citizens for
better quality of
life
Self determination
choice consumerism
Education outside of formal
setting
Assertive user
Lifelong learningeducation
Migration Historical (post
colonial) migration
pan-EU migration
refugees
New needs for education
eg language and culture
Inequalities social
fragmentation
Social Roles Changing family
structure increase
in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
changing gender
roles rising
female
employment rates
Need to reconcile work
and family life
Parentingfamily skills
for vulnerable
parentsfamilies
Socialization of children
ndash social and emotional
deficits for children in
some environments
Work with families and
communities
Continued
inequalities
Inequality in
educational
accessattainment
by socioeconomic
status gender
people with
disabilities ethnic
minorities
Culture of failure
Promise to deliver social
mobility and economic
improvement
(Leadbeater and Wond
2010 pp 5-20)
Inclusive and multicultural
education
Differential support for
children from
lsquodisadvantagedrsquo
backgrounds
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients with
complex comorbidities
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
New group of older
39
learners
Technological
advance
Access to
information new
media technology
making learning
available in new
ways
Self determination
expectations choice
lsquoAssertive userrsquo
Increased exclusion of
some groups with limited
access
Changing
management
styles
philosophies
Community based models
Globalization Need to provide
educationtraining
which is suited to
modern knowledge
based global
economies
This report for the InnoServ project (grant agreement nr 290542) is supported
under the Socio-economic and Humanities Programme of FP7
Chris Hawker
Faculty of Health Sciences University of Southampton Building 67 University Road Highfield Campus Southampton SO17 1BJ
Tel +44 (0)23 8059 7968
Email CHawkersotonacuk
7
personal objectives rather than accept the standardised offerings of social
services organisations
The development of a lsquosocialrsquo rather than lsquomedicalrsquo model for how disability
should be described and understood
Each of these was an innovation some more challenging to the prevailing lsquocarersquo
paradigm than others During the last years of the 20th
century together they
accumulated to deliver a change in the fundamental paradigm informing most
European social systems so that what became an lsquoequalitiesrsquo based framework now
underlies the basis for these social systems (See for example Oliver 1990)
In practice of course these developments occurred simultaneously and in different
places The lsquoequalitiesrsquo arguments developed in the political domain at the same
time and informed and were informed by the practical innovations The
accumulation of the ideas to challenge legal frameworks and care systems occurred
in different ways in differing national contexts The pace of such changes taking
place in Eastern European countries now seeking to adopt these ideas in a single
often politically driven change illustrates an extreme form of lsquoinnovationrsquo adoption
This kind of development reflects processes of knowledge development identified
by Kuhn (1962) as lsquoscientific revolutionrsquo Kuhn noted that developments can occur
within what he calls lsquonormal sciencersquo until individual discoveries appear to challenge
the prevailing paradigm Some accommodations are often then made to the
paradigm but then once enough discoveries appear to challenge the basis of the
prevailing paradigm a new model has to be formed to accommodate the
discoveries lsquoNormalrsquo science can then resume within the new paradigm until this is
then in turn challenged The generation of a new paradigm also creates the
opportunity for new hypotheses which can be tested to form an expanded range of
ideas and knowledge These theories are complex and have developed a number of
critical channels for understanding how knowledge development is shaped or
limited For example some paradigm frameworks disable discovery by forcing a
rigid linguistically determined structure on knowledge development which disables
or actively prevents discovery (see for example Lakatos and Musgrave 1970)
This approach helps to understand how innovative developments in social services
relate to models of social change (see for example Sullivan 1987) Innovations can
occur within social systems but then accumulate to create or require a new social
model for social services The new social lsquomodelrsquo then generates a number of
innovations within the new framework so the equalities based social systems for
people with disabilities continue to generate for example new ideas in
employment for people with disabilities as a part of the lsquoindependent livingrsquo
concept
Innovation development therefore takes place in a dynamic environment Social
services innovations are informing social change and vice versa In order to identify
future innovation trends in social services it is important to understand how
changes in wider society will generate demands for and the development
space for innovation in social services
social services innovation will itself generate new opportunities for social
change
Using this kind of theoretical underpinning this report draws on the INNOSERV
innovation criteria developed in Work Package 1 and reviews the impact of key
societal changes to identify a set of relevant theoretical trends
8
3 Developing and defining innovation criteria
A review of the INNOSERV Work Packages 1 - 3 was undertaken at a meeting of
consortium members in June 2012 The INNOSERV Work Package 1 literature review
(Crepaldi et al 2012) identified a variety of definitions of innovation in services
service innovation and social innovation The literature review provided a first
working definition of innovation in social services shown in box 1 below and also
identified an extensive list of criteria for innovation which is included as appendix
2 This Work Package (2) contributes analysis of the key social challenges driving
innovation in social services Work Package 3 involved the collection of innovative
practice examples using some initial categorisation of innovation (see appendix 1)
BOX 1 INNOSERV first working definition of innovation in social services Innovation in social services can be defined as a type of social innovation process Innovation of social services is delivering services in another way as an answer to current and future challenges in society It mainly concerns (i) designing and implementing new social services to face new needs or unmet needs (ie types of services offered to face autism migrants with an irregular status violence against women) (ii) introducing new social services (or new mechanisms or practices) new interfaces with clients or new practices in social work in pre-existing social services Novelty improvements (effectiveness and efficiency) and sustainability are only first set of criteria to identify innovation in social services Values and the socio-cultural foundations of innovations in the social sphere should be considered Firstly in dealing with social services 1 respond lsquoto pressing social demands which are not addressed by the market and are directed to vulnerable groups in societyrsquo 2 address societal challenges at a level in which the boundary between social and economic blurs and societal challenges are directed towards society as a whole 3 generate systemic changes in changing attitudes and values strategies and policies organisational structures and processes delivery systems and services (Europe 2020 strategy Executive Summary EC) Social services innovations can be considered as ways to enhance processes and the outcome of social innovation Secondly situating social services within a social innovation framework means to focus on ways processes and mechanisms activated by social services that are able (a) to cope with more pressing social needs (b) to stimulate new solutions mobilizing peoples creativity and connecting people ideas and resources to a context of limited resources and rising costs (c) to be able to see social challenges also as opportunities (EC 2010 Murray Caulier-Grice Mulgan 2010) Crepaldi et al 2012 25-26
9
Following the review of these work packages the key elements of innovation for the
INNOSERV project were identified as
relevance to current and future societal challenges
type of innovation response
novelty
improvement
sustainability
context of innovation
These elements were incorporated into the INNOSERV criteria framework developed
to link these key innovation elements together The framework is shown in box 2
Box 2 The INNOSERV criteria framework linking aspects of innovation
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
10
The core of the framework focuses on the ways in which key innovations respond to
drivers and challenges It links distinct types of innovation criteria First there are
those criteria which together define innovation type of innovation or response
novelty and hallmarks of innovation including context improvement and
sustainability Linked to these are drivers or key societal challenges driving
change in social services and other challenges prompting innovation
The remaining sections of this report provide a rationale and explanation of each of
these five separate aspects that make up the framework along with definitions and
explanations of the individual elements within each to provide an analysis against
which the remaining developmental phases of the Innoserv programme can be
assessed
31 Innovation responses innovation in practice
The INNOSERV Work Package 1 literature review and collection of examples has
helped to explicate innovation operating at different lsquolevelsrsquo within service systems
The levels identified in the literature review are shown in summary form in Box 3
and are provided in full including examples in appendix 2
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
11
From this five types of response are detailed within the INNOSERV criteria
framework new service new form of delivery new form of governance new form of
resourcing and new way of evaluation The meaning of these five levels is provided
in table 1 and examples are given to illustrate this It should be noted that the
levels of response are not necessarily exclusive and a specific practice innovation
may fall into more than one category
Box 3 identified levels of innovation in social services
organizational level (ie organization of the provision of social services
type of service target group delivering logics)
regulatory and legislative level (lsquohow services are regulated organised
provided and financed the modalities of service provision the types of
relationships between external service providers and public authoritiesrsquo
EC 2006 p 8)
organizational level ndash connection and cooperation (partnership
networks governance)
professional level (social work methods and practices) -
users level
conceptual level and values
public policy level (policy framework programs and social policies)
financial and economic sustainability level (and scaling-diffusion-
transferability of innovation)
evaluative level and attention to quality (quality standards)
Crepaldi et al 2012 98-99
12
Table 1 Levels of response
Response Definition Example
New service New or improved
product of the scheme
or process
Personalised instead of
generic service
New form of delivery New or improved means
by which the outcome is
achieved
Self-help or social enterprise
instead of government agency
New form of
governance
New or improved way
the scheme or process is
managed and where it
draws authority from
Co-operative or user managed
instead of public service
New form of
resourcing
New or improved
financial human or
physical inputs to the
scheme or process
Grant-funded collectively
staffed organisation instead of
professionally managed
government agency
New way of
evaluation
New or improved
parameters by which
success is judged
User assessment of
effectiveness instead or
professional determined
criteria
It is important to note that innovation within a service is more challenging to define
and measure than innovation in the sense of a product (OECD 2005) while a
product is a tangible entity innovation within service provision can be a either a
product or a process and can occur at different levels of service provision and there
are a number of potential complexities which may inform the structure set out in
table 1
Phills et al (2008) for instance state that social innovation can be
ldquoa product production process or technology (much like innovation in
general) but it can also be a principle an idea a piece of legislation a social
movement an intervention or some combination of themrdquo (39)
In discussing public sector services Hartley (2005) emphasises that innovation is
ldquonot just a new idea but a new practicerdquo (27) and argues therefore that definitions
need to recognise practical impact For services this impact might be at one of
several levels
The organisation literature on innovation offers the initial distinction between
product and process innovation to which other types of innovation have been
added such as position and paradigm innovation (Tidd and Bessant 2009) For
social service oriented innovation further types are added
For example Hartley (2005) identifies the levels of product service process
position strategic governance and rhetorical innovations Hochgerner (2011) adds
social types of innovation to include roles relations norms and values
13
Osborne and Brown (2005) critique a number of typologies to classify innovation
from the management literature They point out that the dichotomy between
process and outcome makes them alternatives whereas an innovation and
particularly innovation in services can be both With services there is often not a
distinct separation between product and process with production delivery and
consumption of services often occurring simultaneously (OECD 2005)
32 Novelty
The next aspect is innovation is novelty In terms of novelty a three way
categorisation is proposed for INNOSERV new perspectives on old needs or
problems new practices for old needs or problems a new practice for a new need
The categorisation reflects the need for innovation to address both existing needs
and new needs Again there is much discussion in the literature about novelty in
relation to innovation Two points are addressed which can be summarised as
lsquowhat degreelevel of novelty equates to innovationrsquo and lsquonew to whomrsquo
The first distinction to be made is between different levels of innovation
ldquoThere are degrees of noveltyrunning from minor incremental
improvements right through to radical changes which transform the way we
think about and use them Sometimes these changes are common to a
particular sector or activity but sometimes they are so radical and far-
reaching that they change the basis of societyhelliprdquo (Tidd and Bessant 2009
27)
Tidd and Bessant usefully break down the incremental-radical continuum as lsquodoing
what we do betterrsquo lsquonew to the enterprisersquo and lsquonew to the worldrsquo (Tidd and
Bessant 2009 38)
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
14
While for some writers a change must be radical or pattern breaking in order to be
innovation it has been argued that within services innovation can be small
adjustments (Fuglsang 2010) Fuglsang in fact argues for a view of innovation in
public sector services as a process of building of skills and expanding routines (68)
The second part of the argument lsquonew to whomrsquo is whether innovation relates to
absolute first use A common to view of innovation is not just those elements
developed within an institution but also those adopted from others (for example
see OECD (2005) for business sector innovation Phills et al (2008) regarding social
innovation Hartley (2005) and Koch (2005) in relation to innovation in public
services) Phills et al (2008) for example state
ldquoAlthough innovations need not necessarily be original they must be new to
the user context or applicationrdquo (Phills et al 37)
Osborne and Brown (2005) purport that most studies consider newness as new to a
person organisation society or situation but not necessarily first use (2005 120)
The authors go on to argue that these are in fact different forms of innovation
differently termed as objective and subjective innovation (Kimberly 1981) or
intrinsic and extrinsic innovation (Downs and Mohr 1976)
Hartley (2005) expounds the dissemination and adaptation of innovation to other
contexts as particularly important for public sector services arguing that public
goals ldquocan be enhanced through collaborative arrangements to create share
transfer adapt and embed good practicerdquo (27) She terms this ldquorsquolateralrsquo innovationrdquo
(33) of good practice adoption and adaption
An example of this approach to defining innovation within social services is seen in
the UK Government policy document on innovation within the National Health
Service which states
ldquoinnovation is as much about applying an idea service or product in a new
context or in a new organisation as it is about creating something newrdquo
(Department of Health 2011 9)
15
33 Hallmarks of innovation
Within social service systems it is not sufficient to focus only on novelty as a
marker of innovation In addition the INNOSERV framework includes certain
hallmarks of innovation including assessment of context quality and sustainability
331 Contextual fit
Different innovative approaches need to fit within different service framework
contexts and need adaptation to those contexts Drawing further on the above
discussion of novelty INNOSERV employ this to mean new to a given (for example
national) context This will reflect the diversity of social service contexts within the
European Union Case studies will also consider transferability of an innovation
from one context to another
332 Improvement in quality
ldquoIn public servicesinnovation is justifiable only where it increases public
value in the quality efficiency or fitness for purpose of governance or
servicesrdquo (Hartley 2005 30)
It is commonly understood that innovation is about improvement as well as novelty
Hartley (2005) offers a model which sets out the possible relationships between
innovation and improvement These relationships are for organisations showing no
improvement and no innovation improvement but no innovation innovation but no
improvement innovation and improvement Important points to highlight from this
model relate to innovation but no improvement first that innovations may not
always lead to success and a level of failure is to be expected second that
innovation can lead to increased but undesired choice loss of performance due to
the process of learning and innovations that are ultimately of no value In terms of
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
16
what is to be measured as improvement Hartley maintains that beyond
improvements in service quality and fitness for purpose wider issues of public
value should be considered
The difficulties of measurement and evaluation of innovation in social services need
to be highlighted as the measures of success within a social project are difficult to
define (Bason 2010 Murray et al 2010) Improvement of social services can
include improved quality of life and access to economic and social opportunity
These issues may relate differently in the fields of health welfare and education
For instance quality of life within health may relate to physical health and mental
wellbeing at different stages of life within welfare issues such as equality of access
to housing cultural and community activities and employment are important
The INNOSERV case studies will include available information on the outcomes of
the innovative project although these will likely vary in terms of types of
measurement used by the projects
333 Sustainability
ldquoInnovation is not just about the originating idea but also the whole process
of the successful development implementation and spread of that idea into
widespread userdquo (Department of Health 2011)
It is recognised that change through innovation needs to be sustainable (Bereiter
2002) Achieving a sustainable innovation may involve streamlining of ideas and
altering them to work in everyday practice (Murray et al 2010 12) The
Normalisation Process Model offered by May and colleagues (May et al 2007 May
et al 2009) provides a theoretical explanation within the context of health care of
the processes through which interventions become embedded in practice and then
integrated and sustained
17
4 Drivers of innovation key societal changes
Innovation within social services needs to be relevant to key social challenges and
changes This relates to the purpose of social services in responding to pressing
social demands and societal needs It is therefore important for the INNOSERV
project to have an understanding of the key social challenges and changes driving
innovation to inform the lsquotheoretical trendsrsquo influencing future innovation
requirements As part of this work package we have therefore sought to identify
social challenges and changes which may act as driving forces of innovation and
shape the development of social service lsquoparadigmsrsquo and hence future social
change
Using a lsquoscenario planningrsquo methodology borrowed from management science can
help to test the limits to any paradigm and identify where new paradigm models
may be needed in the future This in turn should help to identify where future
research interests could be located to explore not just opportunities for innovation
within the current paradigm but also where socially driven change is creating new
opportunities (or indeed requirements) for social and social services innovation
Further these challenges feed into social service provision in terms of an imperative
to address new needs and level of need and issues of rising costs
The INNOSERV project undertook such a scenario planning process the outcomes
of which inform what follows here Using an extended literature study on future
social challenges in the European context a number of key factors promoting a
response from and requiring change in social services were identified Individual
partners made further analysis of the important social challenges within their own
national context The factors were synthesised into a table of key social challenges
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
18
(see appendix 3) separately for health welfare and education sectors although
there was much overlap in the challenges relating to each sector
Small groups involving two country based teams in each case took each social
challenge and considered how it may change and develop given current
understandings of the forces affecting change (some forces may promote change
and some may block change) These were considered against potential political
developments economic developments socialsociological change technological
development legallegislative changes and environmental factors with a focus on
volume nature depth timeframe and scale of importance in influencing future
developments in social services
This work informed extensive discussion at the INNOSERV June 2012 Consortium
meeting with regard to the impact of key future developments on innovation and
the choice of projects which should be used to test key innovation developments
and their relevance to future service development
Relevance is represented in the INNOSERV criteria framework by the lsquodriversrsquo box
which includes a number of examples The most significant social challenges and
changes which were identified by the Consortium as most pertinent to innovation in
social services are listed in table 2 (page 19) and are explored further in the
remainder of this section The selection of projects as case studies has included
analysis of which of these social challenges and changes are being addressed (see
Work Package 4 report Eurich and Strifler 2012)
41 Demographic change as a key societal change driving innovation in the
health and welfare social service sectors
Demographic change was identified as a driving force of innovation in both health
and welfare services in Europe Current demographic change is resulting in
increased numbers of people living longer into old age with a particular increase in
the numbers of people aged over 80 This is alongside a reduction in the numbers
of people of working age in part due to a declining birth rate Further socio-cultural
change is leading to concerns about levels of informal care for older people
While many people will want to live active lives in old age some will live with long
periods of ill health and will have complex care needs resulting from multiple co-
morbidities Most however prefer to live as independently as possible
Questions arise about the ability to meet these increasing care demands from
declining tax income bases In addition the specific needs of elderly patients with
dementia represent a unique challenge for nursing staff and the organisation of
nursing services Financing of the rising health care costs for public agencies or for
health insurance schemes requires sustainable solutions and structural reforms
Traditional models of hospital lsquoacutersquo care may not necessarily be appropriate for
meeting these health care needs
This all highlights the need to find alternative solutions to care needs including the
use of technology and reliance on informal carers Current responses which are
relevant to this driver include integration of health and social care services to
increase cost efficiencies use of technological solutions to enhance self care and
care at home and new paradigms such as Active Ageing
19
Table 2 Key social challenges and changes driving innovation
Social
challengesocial
change driving
innovation
Meaning Social service sector
in which driver is key
Demographic
change
Increase in numbers of over 65s Greatest
increase in over 80 age group Increase in
old age dependency ratio
Health sector
Welfare sector
Aspirations Rising expectations of citizens for better
quality of lifebetter care
Health sector
Education sector
Cross sector services of
education and health
Lifestyles Increase in certain diseases related to
obesity alcohol and drug consumption
and stress diabetes liver disease anxiety
and depression
Health sector
Cross sector services of
education and health
Technology Access to information new media
technology
Health sector
Continued
inequalities
Continued economic inequality
unemployment continued poverty
including child poverty continued
institutionalisation continued inequality for
people with disabilities ethnic minorities
gender inequalities impact of socio-
economic status on health outcomes
Welfare sector
Education sector
Cross sector services of
education and health
and welfare and
education
Independent living The approach now adopted by disabled
people to live as ordinary members of
society and in their chosen domestic
setting
Welfare sector
Social roles Changing families increase in single
households increase in single parent
families changing generational relations
(due to longer life expectancy) reduction in
extended families
Changing gender roles rising female
employment rates
Welfare sector
Education sector
Organisational
changes
Creating new organisational forms
application of more responsive
management processes performance
management culture
Welfare sector
Changing
management
styles
Application of more responsive
management processes
Education sector
Cross sector services of
education and health
20
42 Aspirations as a key societal change driving innovation for health and
for education service sectors
Citizen aspirations were identified as a key societal change acting as a driving force
for innovation within both the health and education sectors and across the
boundary of these sectors Across Europe citizens are expecting a better quality of
life including improved outcomes from health and care services and reduced
inequalities
In terms of the health service sector this both derives from and manifests itself in
a population which is more informed about health issues Consequently patients
wish to be more involved in decisions about their health and their health care
options and are more willing and able to participate in the management of their
condition There is less deference to the medical profession and greater willingness
to make demands on health services There are a growing number of patient led
movements which are challenging some medical traditions
This aspect is fundamental both to everyday practice and to the future development
trajectory for health care services While most health aspirations are limited by
current knowledge and medical skill as research and medical advance offer new
choices and opportunities but at greater costs there will be difficult questions for
political debate This could well result in very different more personalised and
lsquopatient managedrsquo models of health care support
In terms of the education service sector individualism and the connected
aspiration of lsquobeing involvedrsquo has been an increasing trend over the past years and
is expected to keep gaining importance This is not only reflected by agendas of
individually shaped curricula or learning arrangements in school but also by the
opening of the public (ie government funded) school system towards involvement
of the community (seniors in school corporate sponsoring external initiatives of
informal learning and personality formation etc) This is reflected in a similar way
in higher education (eg service learning) and adult education (lsquolearning regionsrsquo)
Across the boundary of health and education aspirations coupled with medical
advance lead to a desire for independence of disabled people and those with long
term conditions This highlights the need for health programs focussed on self
esteem
43 Lifestyles as a key societal challenge driving innovation in the health
service sector and also in the cross sector services of health and education
A key social challenge acting as a driving force for innovation for the health sector
and in the cross sector services of education and health is a recognised growth in
lsquolifestylersquo related conditions arising from unhealthy behaviours such as poor diet
alcohol consumption and smoking (although there is limited evidence of a decline
in smoking rates as its harmful effects are less well tolerated) Political investment
in public health is recognised as an important strategic ambition but often not
matched by financial resources Questions about personal responsibility are also
being asked with suggestions that people with poor health behaviours should not
be given the same priority to responsive health care services As other factors
impacting on health outcomes become more responsive to medical advance these
factors are growing in importance in their impact both on wider society and in
improving overall health outcomes
21
44 Technology as a key societal change driving innovation in the health
service sector
The growth in internet and web based technology is leading to an exponential
growth in access to information and new forms of communication More people
now use the internet as their primary health care information resource Web
lsquocommunitiesrsquo are linking and thus empowering people faced with similar health
challenges Telehealthcare solutions to on-going care needs are becoming more
widely available and are changing the patterns of demands for some health care
services Other new technologies for example in transport and in home assistance
devices are enabling greater independence for disabled people
As future generations use and expect more from access to information and
communication services health care services will have to respond to both the
demands and the opportunities created by such technology Technology can be
seen as both a driving force for innovation and as an enabler of change
45 Continued inequalities as a key societal challenge driving innovation in
welfare and education service sectors also in cross sector services of
education and health and welfare and education
Continued inequalities were identified as a key driving force for innovation within
both welfare and education sectors and in services which straddle the boundary
between education and health services and education and welfare services
Inequalities stem from issues of migration social originbackground
unemployment disability and gender and have been a source of the social
upheaval which has been seen in Europe in recent months
Within health education the link between socio-economic status and health is clear
with people from lower socio-economic groups experiencing poorer health and less
likely engaging in health promoting behaviours In the case of migrants health
messages need to be delivered in a culturally appropriate manner
46 Independent living as a key societal change driving innovation in the
welfare service sector
In terms of disability the emergence and spread of the independent living
philosophy has been a key change driving innovation in the welfare service sector
Typically innovation in this field involves new stakeholder roles with a much more
proactive role for service users in all stages of service provision design
implementation monitoring and fine tuning of services as well as a role in
coordination of different entitlementsservices andor administration and reporting
requirements The boundaries are being pushed further deeper and wider every
day Starting from persons with physical disabilities services are now promoting
active involvement of persons with severe mental disabilities a development that
was deemed impossible only 30 years ago
47 Social roles as a key societal change driving innovation for welfare and
for education service sectors
Changing social roles were identified as a key challenge driving innovation within
the welfare and education sectors These changes are within families and of the
family itself and include changing gender roles and changing family structures (eg
increase in single parent families increase in the numbers of older people living
alone) Families seem to be becoming a sphere of public or community interest
rather than an exclusively private one
Proper lsquosocializationrsquo of children is the key to building viable and sustainable
futures for individuals Early stage family intervention is necessary to prevent the
22
very emergence of conflicts lsquoExternalrsquo interventions often do not reach every day
interaction and thus the root causes of problems This is of significance for family
based projects as well as for care institutions and education providers
48 Organisational changes as a key societal change driving innovation in
welfare service sectors
The shifting of provision of services from the public sector into other sectors such
as independent profit making companies and social enterprises creates new
opportunities for innovation In addition there is an increasing move to provide
services locally in order to be more relevant and responsive and a move to
community based models of care
49 Changing management styles as a key innovation challenge for the
education service sector and in cross sector services of the health and
education sector
Connected to individualism as well as new social roles of individuals family
community and institutions management styles shaped by multi-stakeholder
involvement are gaining importance Community based models do not only increase
the complexity of players involved in the lsquovalue creationrsquo process but also the
enhancement of skill development and personality formation as well as the
fertilization of the educational landscape by innovative ideas expertise and
practices of diverse partners The latter fact also stimulates an increase in cross-
sectoral services (education health and social services) Simultaneously this
situation increases the necessity to spot choose and foster the lsquoinfluencesrsquo and
lsquocombinationsrsquo which realize the highest value through the assessment of social
impact
Increased emphasis is also being placed on illustrating and monitoring
performance Impact measurement and associated tools and practices gain
overarching importance
In terms of changing management styles within the health and education sector an
important aspect is the cooperation of different stakeholders and the involvement
of the community or userrsquos perspective Linked to increased user aspirations
people would like to take part in the development of programs and services With
their special knowledge of their condition for example they can contribute their
expertise within social services
23
5 Other key challenges driving innovation
Sociatal challenges and changes are of course only one driving force of innovation
In addition to these there are other meso and micro level factors which also drive
innovation These include research and development leading to new knowledge
professionally led innovation in response to users needs increasing costs of service
provision and demands for greater efficiency per se and specific political contexts
These other forces are included in the INNOSERV criteria framework in the
lsquochallengesrsquo box These factors are not a key focus for selection of projects for
INNOSERV as they are often very situation specific but will be noted in the case
studies where relevant The factors which prompt or trigger specific innovations
whether socially based or otherwise are not are not mutually exclusive (Bason
2010) and in there is a complex and interacting relationship between a variety of
factors for any given innovation lsquoinstancersquo In addition there are well documented
factors which act to inhibit the development of innovative responses (see Crepaldi
et al 201215)
This work package has sought to identify generic criteria and drivers but it must be
recognised that the dynamics of individual settings and local factors will impact on
the actual processes of adoption
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
24
6 Conclusions and next steps
This report has presented the framework which has been used within the INNOSERV
project to support the choice of innovative case studies and to assist in identifying
the innovation phenomena potential and processes important to future research in
this area The framework has been used to select projects as case studies (see Work
Package 4 report Eurich and Strifler 2012) The framework interlinks aspects of
innovation (novelty type context improvement sustainability) with analysis of
challenges and changes which are acting as driving forces of innovation in social
services As the project is future facing it is proposed that key social challenges
and changes are likely to inform the development of new change paradigms for the
delivery of social services across Europe The framework will inform further
development and testing of concepts through the next stages of the INNOSERVE
programme This process will result in descriptions for the key areas in which future
research on innovation in social services should be taken forward
25
7 Bibliography
Bason C (2010) Leading public sector innovation Co-creating for a better society
Bristol The Policy Press
Bereiter C (2002) Design research for sustained innovation Cognitive Studies
Bulletin of the Japanese Cognitive Society 9 321-327
Christensen CM and Overdorf M (2000) Meeting the Challenge of Disruptive
Change Harvard Business Review March-April
Clark M and Goodwin N (2010) Sustaining innovation in telehealth and telecare
WSDNA briefing paper London The Kings Fund
Crepaldi C De Rosa E And Pesce F (2012) Literature review on innovation in
social services in Europe (sectors of Health Education and Welfare
Services)INNOSERV Work Package 1 report
Department of Health (2011) Innovation Health and Wealth Accelerating Adoption
and Diffusion in the NHS London Department of Health
Eurich J and Strifler A (2012) European compared selection of innovative social
services INNOSERV Work Package 4 report
Fuglsang L (2010) Bricolage and invisible innovation in public service innovation
Journal of Innovation Economics 5 67-87
Greenhalgh T Robert G Macfarlane F Bate P Kyriakidou O (2004) Diffusion of
innovations in service organizations systematic review and recommendations
Milbank Quarterly 82581-629
Hartley J (2005) Innovation in Governance and Public Services Past and Present
Public Money and Management 25127-34
Koch P and Hauknes J (2005) On innovation in the Public Sector Publin report no
D20
Kuhn T (1962) The Structure of Scientific Revolutions Chicago The University of
Chicago Press
Lakatos I and Musgrave A (eds) (1970) Criticism and the growth of knowledge
London Cambridge University Press
May
C Finch T Mair F et al ( 2007) Understanding the implementation of
complex interventions in health care the normalization process model BMC Health
Services Research 2007 7148 doi1011861472-6963-7-148
May et al (2009) Implementing Embedding and Integrating Practices An Outline of
Normalization Process Theory Sociology 43 535-554
Murray R Caulier-Grice J and Mulgan G (2010) The Open Book of Social
Innovation London The Young Foundation
26
OECD (2005) Oslo manual Guidelines for collecting and interpreting innovation
data 3rd
edition
Oliver M (1990) The politics of disablement Basingstoke Macmillan Education Ltd
Osborne S (1998) Naming the Beast Defining and Classifying Service Innovations
in Social Policy Human Relations 51 9 1133-1154
Osborne S and Brown K (2005) Managing Change and Innovation in Public Service
Organizations London Routledge
Phills JA Deiglmeier K and Miller DT (2008) Rediscovering Social Innovation
Stamford Innovation Review 6 4 34-43
Sullivan M (1987) Sociology and Social Welfare London Allen and Unwin
Tidd J and Bessant J (2009) Managing Innovation Integrating Technological
Market and organizational Change 4th
edition Chichester John Wiley and Sons
UK Government Department of Health (2011) Innovation Health and Wealth
Accelerating adoption and diffusion in the NHS London Department of Health
Wolfensburger W (1975) The principle of normalisation in human services Toronto
National Institute on Mental Retardation
27
8 Appendices
Appendix 1 Summary of types and criteria of innovation used in Work Package
3 to identify practices
Identification of social service
Field(s) of service
Logic(s) of service
Self help or mutual aid logic Social care logic Multi-stakeholders logic Social
movements logic Combination
Activities of services delivered
Assistance for persons faced with personal challenges or crises (debt unemployment
drug addiction other) (Re)integration of persons into society (rehabilitation language
training for immigrants other) Services to the labour market (occupational training)
Social housing for disadvantaged groups Care (for the elderly children families )
Treatment and support of people with physical illnesses Treatment and support of
people with mental health problems Combination
Status of the provider organization
Public organization (governmental) Private organization ndash nonnot for profit Private
organization ndash profit Volunteer association Cooperative company or mutual company
Familyneighbourhood Civil society network Combination Other
Target group
Children Youngsters Elder people Unemployed people Poor people Immigrants
Disabled people People with chronic diseases ndash long-term health problems People with
acute or short term health problems No specific target group (eg territory-based social
services provision aiming at strengthen social ties) Combination Other
Size of the organization
Innovation
Type of innovation
New forms of organization resources hybridization new targeted actions new services
non-structural practices other
Innovative character
do the service practices appear to be something new in the field of social services
Origins of innovation
Supply side demand side broader operating factors
Impact on service performance
Effectiveness of service delivery
from user perspective cost effectivenesscapacity building sustainability of
innovation
Quality of provision
28
Socialization quality of life as judged by users and beneficiaries more inclusion
lower risk on exclusion participation of the user transition from institutional to
community based care
Potential wider effects
Promoting social and health equality sustainability new skills and jobs
increased social rights affordability of adequate and high quality health and long-
term care promotion of equality and non-discrimination equal access to adequate
provision
Transferability of innovations between national contexts
29
Appendix 2 levels of innovation identified within INNOSERV Work Package 2
literature review
Organizational level (policy organizational sectors)
New social services designed to face new needs or unmet needs
Search for new solutions to old needs new mechanisms or practices introduced in
preexisting
social services
to improve access to social services (ie more information increased
professionalism in
social work sector)
to guarantee entitlements (rights) for specific groups or minorities
to satisfy the demand for social services in a more complete and broad way
(holistic
approach)
to guarantee more participation and inclusion of citizens
New and increased Cross-Sectoral social services
Cross-Sectoral social services (ie teaching art to children while helping their mothers
for
job seeking and offering jobs for young artists)
Integrated care practices
Tearing down walls between sectors and the role of informal care
Sharing of knowledge
Better integration of Health and Social sector services
Territory based social services that contribute to the creation of training and job
opportunities for disadvantaged people
Solidarity-based social services
Social mediation for impaired and weakened people
Easy access to housing for poor families
New interfaces with clients
Logic(s) of service Self help or mutual aid logic Social care logic Multi-stakeholders
logic
Social movements logic
The development of the self-help sector
Actors New organizations (Cooperative society for social service provision ndashSCOP
Cooperative society as social enterprise with userrsquos involvement ndashSCIC)
New legal forms within structured public frameworks (Italy social cooperatives)
New provider organizations and existing organisations refashioned by new dynamics
New roles and relations among actors
New private organizations for profit and non-profit
Management style in the organization
Regulatory and legislative level
New architecture of the provision system
Socially responsible public contracts and social clauses (outsourcing)
Adherence to EU standards in transitional economies
Impact on institutional framework that shape innovation in social services
New arrangement between one or more government agencies andor external
organization
Organizational level ndash Connection and Cooperation (governance and partnership)
New networks and social movements established in order to design deliver and
finance
social services
Cooperation between sectors actors and different forms of provision
Cooperation between local actors
Increasing communication responsiveness
30
Utilizing connectivity and interdependencies
Modification of organizational systems (models of governance work organisation
number
of involved stakeholders in governance)
Public sector and local authorities as promoters of innovation and promoters of
crosssectoral
policy strategies
Third sector and user as promoters of innovation
Volunteer workers and initiatives launched by a group of citizens
Third sector and userrsquos engagement design (co-design and re-design services)
Joint decision process
Decision-making power not based on capital ownership
Employee and user driven innovation
Partnerships with users family carers and user organizations
Partnership between service users practitioners and academics
Community-based and participative health network in a local territory
Collaboration between public and volunteer organisations (NGOs) or between civil and
local
networks in collaboration with public organisations and social enterprises
New techniques for partnership building and functioning
Impact on social and power relations
Professional level (practitioners)
New practices in social work
Innovative tools (ie Theatre of the Oppressed) and the use of participated methods in
social
work (ie self-help group)
Networking
Individualised supports
New professional skills in social work
The use of informatics and new technologies in social work
Users
Participation and involvement of final users of services in designing delivering and
evaluating social services
Involvement of final users in promoting equality effectiveness and control and
adherence
to the needs of users
Conceptual Level (and value)
New models of society - Social goals participation user involvement community
benefit
New paradigms underlying a new social service concept or service delivery model (ie
new
inclusion paradigm active ageing)
Relationships and trust
Pursuing diversity
Better adjustment to usersrsquo needs more person centred support
More social services provision in less developed regions
New concept of accessibility of the service (ie for Roma families)
The concept of lsquoprogressive universalismrsquo
The Social Care Model
De-institutionalization and community care Improved home-based and community
services
Gender and diversity perspectives
Anti-discrimination and equality process
Increase of the level of recognition of social values objectives paradigms and goals
New models of interaction leading to social innovation processes
31
Public policy level (policy framework programs and social policies)
The new role of the system governance played by central (or local depending on
national
arrangements) government
Impact on public policies new public policy programme measure or intervention
Joint construction of a space for public action and redefinition of public governance
bodies
and methods
Innovative logics for public policies
Innovating the public sector
The new wide attention on anti stigma policies
E-government
Financial and economic sustainability level (and scaling-diffusion-transferability
of innovation)
New ways to overcome budgetary constraints
New approaches to acquire funding
The involvement of private investors
The introduction of special funds
The purchase of innovative practices by final users
Hybridization of resources (market redistribution and reciprocity resources)
New investment sources
Mobilising community resources taking full advantage of all endogenous resources
Improvement in efficiency and effectiveness
Financial and systemic sustainability Impact on the economy
Economic Environmental and Social Sustainability of Territory based social services
Financial tools necessary to territorial social initiatives and the way to unlock them
Capacity of spreading and diffusion
Evaluative level and attention for quality
Affordability availability and accessibility
New standards expected
New feedback loops from users and specialists
Social services of excellence as for quality efficiency and efficacy
New methods and creative tool-kits to strengthen and renew the quality of social care
services
Low-cost (for user) and high level quality of social services
Quality assurance moderation and accreditation mechanisms
New tools for monitoring social services - hearing all voices (users organizations
practioners staff family and friends)
Action research
Alternative economic and social indicators
Social impact and contribution of innovation in social services to social innovation and
social change ndash Assessment of innovation
Learning approach to evaluation ndash lsquoto learn from failuresrsquo
Developmental evaluation
Specifics for the Health sector
Disability from rehabilitation to integration and then to inclusion
Mental Health from segregation to inclusion and community care
HIV from segregationstigmatization to awareness campaigns for promoting self
protection
Innovation in the area of prevention of treatment and in the introduction of new
technologies
Emphasis on an inter-sectoral controlled and steered care in managed care models
replacement of the traditional insurance model
Integrated services
Technological progress
32
Specifics for the Education sector
Inclusive education
Inclusive education and training in collaboration with the civil society
Multicultural education
Integration of disciplines
Alternative schools non-regular schools and informal education
Link between formal and informal education
Community development based approaches
Connection between regular school and the system of social services
Experiential learning
Human rights education
Working lsquothrough relationshipsrsquo with children and young people
Problem based learning methodology
The lsquomedia educationrsquo The use of comics
ICT in schools
E-inclusion
Networks of schools
Improve supplement reinvent and transform learning
Sustained educational improvement
Learning Beyond the Classroom
Spreading a culture that values learning
More personalized approaches to learning
Using the web
Learning with and by not to and from
33
Appendix 3 analysis of social challenges and changes driving innovation
Welfare
Societal
change as
driving force
of innovation
in social
services
Meaning
description
Related
outcomesother
factors
Examples of innovative
responses
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
Empowerment self-
determination choice
The lsquoassertive userrsquo
Demand for more
individualised services of
better quality
Alternativecomplementary
providers
Personalisation
Co-production (new
userprofessional
relationships)
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demand on services
Potential for poor access
to services (from
communication
problems social
isolation)
Multiculturalism
Integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Declining female
caregiving
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
34
Increased demand for
services demand for
formal care
Continued
inequality
Continued
economic
inequality
unemployment
continued poverty
including child
poverty continued
institutionalisation
continued
inequality for
people with
disabilities ethnic
minorities gender
inequalities
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients
with complex
comorbidities increase
in certain diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing demand for
services Increasing
costsneed to make
limited resources go
further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
Decisions about value
marketization
Technological
development
Access to
information new
media technology
Facilitates self
determination increases
expectations and choice
population better
informed about
conditionsservicesright
s and less deferential
Users better able to
35
mobilise
Increased exclusion of
some groups with limited
access
New models of remote
care provision
Ability to exchange
information on quality
and experience
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Increasing costs
Decisions about value
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Organisational
change changing
management
styles
philosophies
Creating new
organisational
forms application
of more responsive
management
processes
performance
management
culture
Integration of
organisationsfunctions
new approaches to
lsquocommissioningrsquo of
organisationsservices
distortions caused by
lsquolocked inrsquo expenditures
(tertiary health care
residential care)
Decentralisation
deinstitutionalisation
marketization liberalisation
The lsquoenabling
statersquo Political
will fiscal space
Impact of financial
crisis competing
priorities for public
funds
Legacy of category-based
(not needs based) social
protection structural
transition
deindustrialisation
Health
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
EmpowermentSelf-
determination choice
Demand for more
individualised services of
better quality
Users better able to mobilise
Assertive lsquouserrsquo
knowledgeable patient
Alternativecomplimentary
providers
36
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demands on
services
Potential for poor access
to services (from
communication
problems social
isolation)
MulticulturalismTrained
health professionals
move to richer countries
integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Declining female
caregiving
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
Increased demand for
formal care services
Continued
inequalities
Unequal
distribution of
health risks and
health
outcomediseases
by socioeconomic
indicators
Unequal access to
care by social
status geography
gender and
ethnicity
Demographic Increase in
numbers of over
Increase in patients with
complex comorbidities
Increasing demand for care
Decisions about value Active
37
change 65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing costsneed to
make limited resources
go further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
ageing paradigm
Technological
development
Access to
information new
media technology
Self determination
expectations choice
population better
informed about
conditionsservicesright
s and less deferential
Ability to exchange
information on quality
and experience
New models of care provision
(eg telehealth care) new
health management systems
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Changing
management
stylesphilosophi
es
Application of
more responsive
management
processes
Decentralisation
deinstitutionalisation
marketization liberalisation
Lifestyle changes Increase in certain
diseases related to
obesity alcohol
and drug
Increasing
costsdemands for care
38
consumption and
stress diabetes
liver disease
anxiety and
depression
Education
Aspirations Rising expectations
by citizens for
better quality of
life
Self determination
choice consumerism
Education outside of formal
setting
Assertive user
Lifelong learningeducation
Migration Historical (post
colonial) migration
pan-EU migration
refugees
New needs for education
eg language and culture
Inequalities social
fragmentation
Social Roles Changing family
structure increase
in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
changing gender
roles rising
female
employment rates
Need to reconcile work
and family life
Parentingfamily skills
for vulnerable
parentsfamilies
Socialization of children
ndash social and emotional
deficits for children in
some environments
Work with families and
communities
Continued
inequalities
Inequality in
educational
accessattainment
by socioeconomic
status gender
people with
disabilities ethnic
minorities
Culture of failure
Promise to deliver social
mobility and economic
improvement
(Leadbeater and Wond
2010 pp 5-20)
Inclusive and multicultural
education
Differential support for
children from
lsquodisadvantagedrsquo
backgrounds
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients with
complex comorbidities
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
New group of older
39
learners
Technological
advance
Access to
information new
media technology
making learning
available in new
ways
Self determination
expectations choice
lsquoAssertive userrsquo
Increased exclusion of
some groups with limited
access
Changing
management
styles
philosophies
Community based models
Globalization Need to provide
educationtraining
which is suited to
modern knowledge
based global
economies
This report for the InnoServ project (grant agreement nr 290542) is supported
under the Socio-economic and Humanities Programme of FP7
Chris Hawker
Faculty of Health Sciences University of Southampton Building 67 University Road Highfield Campus Southampton SO17 1BJ
Tel +44 (0)23 8059 7968
Email CHawkersotonacuk
8
3 Developing and defining innovation criteria
A review of the INNOSERV Work Packages 1 - 3 was undertaken at a meeting of
consortium members in June 2012 The INNOSERV Work Package 1 literature review
(Crepaldi et al 2012) identified a variety of definitions of innovation in services
service innovation and social innovation The literature review provided a first
working definition of innovation in social services shown in box 1 below and also
identified an extensive list of criteria for innovation which is included as appendix
2 This Work Package (2) contributes analysis of the key social challenges driving
innovation in social services Work Package 3 involved the collection of innovative
practice examples using some initial categorisation of innovation (see appendix 1)
BOX 1 INNOSERV first working definition of innovation in social services Innovation in social services can be defined as a type of social innovation process Innovation of social services is delivering services in another way as an answer to current and future challenges in society It mainly concerns (i) designing and implementing new social services to face new needs or unmet needs (ie types of services offered to face autism migrants with an irregular status violence against women) (ii) introducing new social services (or new mechanisms or practices) new interfaces with clients or new practices in social work in pre-existing social services Novelty improvements (effectiveness and efficiency) and sustainability are only first set of criteria to identify innovation in social services Values and the socio-cultural foundations of innovations in the social sphere should be considered Firstly in dealing with social services 1 respond lsquoto pressing social demands which are not addressed by the market and are directed to vulnerable groups in societyrsquo 2 address societal challenges at a level in which the boundary between social and economic blurs and societal challenges are directed towards society as a whole 3 generate systemic changes in changing attitudes and values strategies and policies organisational structures and processes delivery systems and services (Europe 2020 strategy Executive Summary EC) Social services innovations can be considered as ways to enhance processes and the outcome of social innovation Secondly situating social services within a social innovation framework means to focus on ways processes and mechanisms activated by social services that are able (a) to cope with more pressing social needs (b) to stimulate new solutions mobilizing peoples creativity and connecting people ideas and resources to a context of limited resources and rising costs (c) to be able to see social challenges also as opportunities (EC 2010 Murray Caulier-Grice Mulgan 2010) Crepaldi et al 2012 25-26
9
Following the review of these work packages the key elements of innovation for the
INNOSERV project were identified as
relevance to current and future societal challenges
type of innovation response
novelty
improvement
sustainability
context of innovation
These elements were incorporated into the INNOSERV criteria framework developed
to link these key innovation elements together The framework is shown in box 2
Box 2 The INNOSERV criteria framework linking aspects of innovation
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
10
The core of the framework focuses on the ways in which key innovations respond to
drivers and challenges It links distinct types of innovation criteria First there are
those criteria which together define innovation type of innovation or response
novelty and hallmarks of innovation including context improvement and
sustainability Linked to these are drivers or key societal challenges driving
change in social services and other challenges prompting innovation
The remaining sections of this report provide a rationale and explanation of each of
these five separate aspects that make up the framework along with definitions and
explanations of the individual elements within each to provide an analysis against
which the remaining developmental phases of the Innoserv programme can be
assessed
31 Innovation responses innovation in practice
The INNOSERV Work Package 1 literature review and collection of examples has
helped to explicate innovation operating at different lsquolevelsrsquo within service systems
The levels identified in the literature review are shown in summary form in Box 3
and are provided in full including examples in appendix 2
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
11
From this five types of response are detailed within the INNOSERV criteria
framework new service new form of delivery new form of governance new form of
resourcing and new way of evaluation The meaning of these five levels is provided
in table 1 and examples are given to illustrate this It should be noted that the
levels of response are not necessarily exclusive and a specific practice innovation
may fall into more than one category
Box 3 identified levels of innovation in social services
organizational level (ie organization of the provision of social services
type of service target group delivering logics)
regulatory and legislative level (lsquohow services are regulated organised
provided and financed the modalities of service provision the types of
relationships between external service providers and public authoritiesrsquo
EC 2006 p 8)
organizational level ndash connection and cooperation (partnership
networks governance)
professional level (social work methods and practices) -
users level
conceptual level and values
public policy level (policy framework programs and social policies)
financial and economic sustainability level (and scaling-diffusion-
transferability of innovation)
evaluative level and attention to quality (quality standards)
Crepaldi et al 2012 98-99
12
Table 1 Levels of response
Response Definition Example
New service New or improved
product of the scheme
or process
Personalised instead of
generic service
New form of delivery New or improved means
by which the outcome is
achieved
Self-help or social enterprise
instead of government agency
New form of
governance
New or improved way
the scheme or process is
managed and where it
draws authority from
Co-operative or user managed
instead of public service
New form of
resourcing
New or improved
financial human or
physical inputs to the
scheme or process
Grant-funded collectively
staffed organisation instead of
professionally managed
government agency
New way of
evaluation
New or improved
parameters by which
success is judged
User assessment of
effectiveness instead or
professional determined
criteria
It is important to note that innovation within a service is more challenging to define
and measure than innovation in the sense of a product (OECD 2005) while a
product is a tangible entity innovation within service provision can be a either a
product or a process and can occur at different levels of service provision and there
are a number of potential complexities which may inform the structure set out in
table 1
Phills et al (2008) for instance state that social innovation can be
ldquoa product production process or technology (much like innovation in
general) but it can also be a principle an idea a piece of legislation a social
movement an intervention or some combination of themrdquo (39)
In discussing public sector services Hartley (2005) emphasises that innovation is
ldquonot just a new idea but a new practicerdquo (27) and argues therefore that definitions
need to recognise practical impact For services this impact might be at one of
several levels
The organisation literature on innovation offers the initial distinction between
product and process innovation to which other types of innovation have been
added such as position and paradigm innovation (Tidd and Bessant 2009) For
social service oriented innovation further types are added
For example Hartley (2005) identifies the levels of product service process
position strategic governance and rhetorical innovations Hochgerner (2011) adds
social types of innovation to include roles relations norms and values
13
Osborne and Brown (2005) critique a number of typologies to classify innovation
from the management literature They point out that the dichotomy between
process and outcome makes them alternatives whereas an innovation and
particularly innovation in services can be both With services there is often not a
distinct separation between product and process with production delivery and
consumption of services often occurring simultaneously (OECD 2005)
32 Novelty
The next aspect is innovation is novelty In terms of novelty a three way
categorisation is proposed for INNOSERV new perspectives on old needs or
problems new practices for old needs or problems a new practice for a new need
The categorisation reflects the need for innovation to address both existing needs
and new needs Again there is much discussion in the literature about novelty in
relation to innovation Two points are addressed which can be summarised as
lsquowhat degreelevel of novelty equates to innovationrsquo and lsquonew to whomrsquo
The first distinction to be made is between different levels of innovation
ldquoThere are degrees of noveltyrunning from minor incremental
improvements right through to radical changes which transform the way we
think about and use them Sometimes these changes are common to a
particular sector or activity but sometimes they are so radical and far-
reaching that they change the basis of societyhelliprdquo (Tidd and Bessant 2009
27)
Tidd and Bessant usefully break down the incremental-radical continuum as lsquodoing
what we do betterrsquo lsquonew to the enterprisersquo and lsquonew to the worldrsquo (Tidd and
Bessant 2009 38)
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
14
While for some writers a change must be radical or pattern breaking in order to be
innovation it has been argued that within services innovation can be small
adjustments (Fuglsang 2010) Fuglsang in fact argues for a view of innovation in
public sector services as a process of building of skills and expanding routines (68)
The second part of the argument lsquonew to whomrsquo is whether innovation relates to
absolute first use A common to view of innovation is not just those elements
developed within an institution but also those adopted from others (for example
see OECD (2005) for business sector innovation Phills et al (2008) regarding social
innovation Hartley (2005) and Koch (2005) in relation to innovation in public
services) Phills et al (2008) for example state
ldquoAlthough innovations need not necessarily be original they must be new to
the user context or applicationrdquo (Phills et al 37)
Osborne and Brown (2005) purport that most studies consider newness as new to a
person organisation society or situation but not necessarily first use (2005 120)
The authors go on to argue that these are in fact different forms of innovation
differently termed as objective and subjective innovation (Kimberly 1981) or
intrinsic and extrinsic innovation (Downs and Mohr 1976)
Hartley (2005) expounds the dissemination and adaptation of innovation to other
contexts as particularly important for public sector services arguing that public
goals ldquocan be enhanced through collaborative arrangements to create share
transfer adapt and embed good practicerdquo (27) She terms this ldquorsquolateralrsquo innovationrdquo
(33) of good practice adoption and adaption
An example of this approach to defining innovation within social services is seen in
the UK Government policy document on innovation within the National Health
Service which states
ldquoinnovation is as much about applying an idea service or product in a new
context or in a new organisation as it is about creating something newrdquo
(Department of Health 2011 9)
15
33 Hallmarks of innovation
Within social service systems it is not sufficient to focus only on novelty as a
marker of innovation In addition the INNOSERV framework includes certain
hallmarks of innovation including assessment of context quality and sustainability
331 Contextual fit
Different innovative approaches need to fit within different service framework
contexts and need adaptation to those contexts Drawing further on the above
discussion of novelty INNOSERV employ this to mean new to a given (for example
national) context This will reflect the diversity of social service contexts within the
European Union Case studies will also consider transferability of an innovation
from one context to another
332 Improvement in quality
ldquoIn public servicesinnovation is justifiable only where it increases public
value in the quality efficiency or fitness for purpose of governance or
servicesrdquo (Hartley 2005 30)
It is commonly understood that innovation is about improvement as well as novelty
Hartley (2005) offers a model which sets out the possible relationships between
innovation and improvement These relationships are for organisations showing no
improvement and no innovation improvement but no innovation innovation but no
improvement innovation and improvement Important points to highlight from this
model relate to innovation but no improvement first that innovations may not
always lead to success and a level of failure is to be expected second that
innovation can lead to increased but undesired choice loss of performance due to
the process of learning and innovations that are ultimately of no value In terms of
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
16
what is to be measured as improvement Hartley maintains that beyond
improvements in service quality and fitness for purpose wider issues of public
value should be considered
The difficulties of measurement and evaluation of innovation in social services need
to be highlighted as the measures of success within a social project are difficult to
define (Bason 2010 Murray et al 2010) Improvement of social services can
include improved quality of life and access to economic and social opportunity
These issues may relate differently in the fields of health welfare and education
For instance quality of life within health may relate to physical health and mental
wellbeing at different stages of life within welfare issues such as equality of access
to housing cultural and community activities and employment are important
The INNOSERV case studies will include available information on the outcomes of
the innovative project although these will likely vary in terms of types of
measurement used by the projects
333 Sustainability
ldquoInnovation is not just about the originating idea but also the whole process
of the successful development implementation and spread of that idea into
widespread userdquo (Department of Health 2011)
It is recognised that change through innovation needs to be sustainable (Bereiter
2002) Achieving a sustainable innovation may involve streamlining of ideas and
altering them to work in everyday practice (Murray et al 2010 12) The
Normalisation Process Model offered by May and colleagues (May et al 2007 May
et al 2009) provides a theoretical explanation within the context of health care of
the processes through which interventions become embedded in practice and then
integrated and sustained
17
4 Drivers of innovation key societal changes
Innovation within social services needs to be relevant to key social challenges and
changes This relates to the purpose of social services in responding to pressing
social demands and societal needs It is therefore important for the INNOSERV
project to have an understanding of the key social challenges and changes driving
innovation to inform the lsquotheoretical trendsrsquo influencing future innovation
requirements As part of this work package we have therefore sought to identify
social challenges and changes which may act as driving forces of innovation and
shape the development of social service lsquoparadigmsrsquo and hence future social
change
Using a lsquoscenario planningrsquo methodology borrowed from management science can
help to test the limits to any paradigm and identify where new paradigm models
may be needed in the future This in turn should help to identify where future
research interests could be located to explore not just opportunities for innovation
within the current paradigm but also where socially driven change is creating new
opportunities (or indeed requirements) for social and social services innovation
Further these challenges feed into social service provision in terms of an imperative
to address new needs and level of need and issues of rising costs
The INNOSERV project undertook such a scenario planning process the outcomes
of which inform what follows here Using an extended literature study on future
social challenges in the European context a number of key factors promoting a
response from and requiring change in social services were identified Individual
partners made further analysis of the important social challenges within their own
national context The factors were synthesised into a table of key social challenges
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
18
(see appendix 3) separately for health welfare and education sectors although
there was much overlap in the challenges relating to each sector
Small groups involving two country based teams in each case took each social
challenge and considered how it may change and develop given current
understandings of the forces affecting change (some forces may promote change
and some may block change) These were considered against potential political
developments economic developments socialsociological change technological
development legallegislative changes and environmental factors with a focus on
volume nature depth timeframe and scale of importance in influencing future
developments in social services
This work informed extensive discussion at the INNOSERV June 2012 Consortium
meeting with regard to the impact of key future developments on innovation and
the choice of projects which should be used to test key innovation developments
and their relevance to future service development
Relevance is represented in the INNOSERV criteria framework by the lsquodriversrsquo box
which includes a number of examples The most significant social challenges and
changes which were identified by the Consortium as most pertinent to innovation in
social services are listed in table 2 (page 19) and are explored further in the
remainder of this section The selection of projects as case studies has included
analysis of which of these social challenges and changes are being addressed (see
Work Package 4 report Eurich and Strifler 2012)
41 Demographic change as a key societal change driving innovation in the
health and welfare social service sectors
Demographic change was identified as a driving force of innovation in both health
and welfare services in Europe Current demographic change is resulting in
increased numbers of people living longer into old age with a particular increase in
the numbers of people aged over 80 This is alongside a reduction in the numbers
of people of working age in part due to a declining birth rate Further socio-cultural
change is leading to concerns about levels of informal care for older people
While many people will want to live active lives in old age some will live with long
periods of ill health and will have complex care needs resulting from multiple co-
morbidities Most however prefer to live as independently as possible
Questions arise about the ability to meet these increasing care demands from
declining tax income bases In addition the specific needs of elderly patients with
dementia represent a unique challenge for nursing staff and the organisation of
nursing services Financing of the rising health care costs for public agencies or for
health insurance schemes requires sustainable solutions and structural reforms
Traditional models of hospital lsquoacutersquo care may not necessarily be appropriate for
meeting these health care needs
This all highlights the need to find alternative solutions to care needs including the
use of technology and reliance on informal carers Current responses which are
relevant to this driver include integration of health and social care services to
increase cost efficiencies use of technological solutions to enhance self care and
care at home and new paradigms such as Active Ageing
19
Table 2 Key social challenges and changes driving innovation
Social
challengesocial
change driving
innovation
Meaning Social service sector
in which driver is key
Demographic
change
Increase in numbers of over 65s Greatest
increase in over 80 age group Increase in
old age dependency ratio
Health sector
Welfare sector
Aspirations Rising expectations of citizens for better
quality of lifebetter care
Health sector
Education sector
Cross sector services of
education and health
Lifestyles Increase in certain diseases related to
obesity alcohol and drug consumption
and stress diabetes liver disease anxiety
and depression
Health sector
Cross sector services of
education and health
Technology Access to information new media
technology
Health sector
Continued
inequalities
Continued economic inequality
unemployment continued poverty
including child poverty continued
institutionalisation continued inequality for
people with disabilities ethnic minorities
gender inequalities impact of socio-
economic status on health outcomes
Welfare sector
Education sector
Cross sector services of
education and health
and welfare and
education
Independent living The approach now adopted by disabled
people to live as ordinary members of
society and in their chosen domestic
setting
Welfare sector
Social roles Changing families increase in single
households increase in single parent
families changing generational relations
(due to longer life expectancy) reduction in
extended families
Changing gender roles rising female
employment rates
Welfare sector
Education sector
Organisational
changes
Creating new organisational forms
application of more responsive
management processes performance
management culture
Welfare sector
Changing
management
styles
Application of more responsive
management processes
Education sector
Cross sector services of
education and health
20
42 Aspirations as a key societal change driving innovation for health and
for education service sectors
Citizen aspirations were identified as a key societal change acting as a driving force
for innovation within both the health and education sectors and across the
boundary of these sectors Across Europe citizens are expecting a better quality of
life including improved outcomes from health and care services and reduced
inequalities
In terms of the health service sector this both derives from and manifests itself in
a population which is more informed about health issues Consequently patients
wish to be more involved in decisions about their health and their health care
options and are more willing and able to participate in the management of their
condition There is less deference to the medical profession and greater willingness
to make demands on health services There are a growing number of patient led
movements which are challenging some medical traditions
This aspect is fundamental both to everyday practice and to the future development
trajectory for health care services While most health aspirations are limited by
current knowledge and medical skill as research and medical advance offer new
choices and opportunities but at greater costs there will be difficult questions for
political debate This could well result in very different more personalised and
lsquopatient managedrsquo models of health care support
In terms of the education service sector individualism and the connected
aspiration of lsquobeing involvedrsquo has been an increasing trend over the past years and
is expected to keep gaining importance This is not only reflected by agendas of
individually shaped curricula or learning arrangements in school but also by the
opening of the public (ie government funded) school system towards involvement
of the community (seniors in school corporate sponsoring external initiatives of
informal learning and personality formation etc) This is reflected in a similar way
in higher education (eg service learning) and adult education (lsquolearning regionsrsquo)
Across the boundary of health and education aspirations coupled with medical
advance lead to a desire for independence of disabled people and those with long
term conditions This highlights the need for health programs focussed on self
esteem
43 Lifestyles as a key societal challenge driving innovation in the health
service sector and also in the cross sector services of health and education
A key social challenge acting as a driving force for innovation for the health sector
and in the cross sector services of education and health is a recognised growth in
lsquolifestylersquo related conditions arising from unhealthy behaviours such as poor diet
alcohol consumption and smoking (although there is limited evidence of a decline
in smoking rates as its harmful effects are less well tolerated) Political investment
in public health is recognised as an important strategic ambition but often not
matched by financial resources Questions about personal responsibility are also
being asked with suggestions that people with poor health behaviours should not
be given the same priority to responsive health care services As other factors
impacting on health outcomes become more responsive to medical advance these
factors are growing in importance in their impact both on wider society and in
improving overall health outcomes
21
44 Technology as a key societal change driving innovation in the health
service sector
The growth in internet and web based technology is leading to an exponential
growth in access to information and new forms of communication More people
now use the internet as their primary health care information resource Web
lsquocommunitiesrsquo are linking and thus empowering people faced with similar health
challenges Telehealthcare solutions to on-going care needs are becoming more
widely available and are changing the patterns of demands for some health care
services Other new technologies for example in transport and in home assistance
devices are enabling greater independence for disabled people
As future generations use and expect more from access to information and
communication services health care services will have to respond to both the
demands and the opportunities created by such technology Technology can be
seen as both a driving force for innovation and as an enabler of change
45 Continued inequalities as a key societal challenge driving innovation in
welfare and education service sectors also in cross sector services of
education and health and welfare and education
Continued inequalities were identified as a key driving force for innovation within
both welfare and education sectors and in services which straddle the boundary
between education and health services and education and welfare services
Inequalities stem from issues of migration social originbackground
unemployment disability and gender and have been a source of the social
upheaval which has been seen in Europe in recent months
Within health education the link between socio-economic status and health is clear
with people from lower socio-economic groups experiencing poorer health and less
likely engaging in health promoting behaviours In the case of migrants health
messages need to be delivered in a culturally appropriate manner
46 Independent living as a key societal change driving innovation in the
welfare service sector
In terms of disability the emergence and spread of the independent living
philosophy has been a key change driving innovation in the welfare service sector
Typically innovation in this field involves new stakeholder roles with a much more
proactive role for service users in all stages of service provision design
implementation monitoring and fine tuning of services as well as a role in
coordination of different entitlementsservices andor administration and reporting
requirements The boundaries are being pushed further deeper and wider every
day Starting from persons with physical disabilities services are now promoting
active involvement of persons with severe mental disabilities a development that
was deemed impossible only 30 years ago
47 Social roles as a key societal change driving innovation for welfare and
for education service sectors
Changing social roles were identified as a key challenge driving innovation within
the welfare and education sectors These changes are within families and of the
family itself and include changing gender roles and changing family structures (eg
increase in single parent families increase in the numbers of older people living
alone) Families seem to be becoming a sphere of public or community interest
rather than an exclusively private one
Proper lsquosocializationrsquo of children is the key to building viable and sustainable
futures for individuals Early stage family intervention is necessary to prevent the
22
very emergence of conflicts lsquoExternalrsquo interventions often do not reach every day
interaction and thus the root causes of problems This is of significance for family
based projects as well as for care institutions and education providers
48 Organisational changes as a key societal change driving innovation in
welfare service sectors
The shifting of provision of services from the public sector into other sectors such
as independent profit making companies and social enterprises creates new
opportunities for innovation In addition there is an increasing move to provide
services locally in order to be more relevant and responsive and a move to
community based models of care
49 Changing management styles as a key innovation challenge for the
education service sector and in cross sector services of the health and
education sector
Connected to individualism as well as new social roles of individuals family
community and institutions management styles shaped by multi-stakeholder
involvement are gaining importance Community based models do not only increase
the complexity of players involved in the lsquovalue creationrsquo process but also the
enhancement of skill development and personality formation as well as the
fertilization of the educational landscape by innovative ideas expertise and
practices of diverse partners The latter fact also stimulates an increase in cross-
sectoral services (education health and social services) Simultaneously this
situation increases the necessity to spot choose and foster the lsquoinfluencesrsquo and
lsquocombinationsrsquo which realize the highest value through the assessment of social
impact
Increased emphasis is also being placed on illustrating and monitoring
performance Impact measurement and associated tools and practices gain
overarching importance
In terms of changing management styles within the health and education sector an
important aspect is the cooperation of different stakeholders and the involvement
of the community or userrsquos perspective Linked to increased user aspirations
people would like to take part in the development of programs and services With
their special knowledge of their condition for example they can contribute their
expertise within social services
23
5 Other key challenges driving innovation
Sociatal challenges and changes are of course only one driving force of innovation
In addition to these there are other meso and micro level factors which also drive
innovation These include research and development leading to new knowledge
professionally led innovation in response to users needs increasing costs of service
provision and demands for greater efficiency per se and specific political contexts
These other forces are included in the INNOSERV criteria framework in the
lsquochallengesrsquo box These factors are not a key focus for selection of projects for
INNOSERV as they are often very situation specific but will be noted in the case
studies where relevant The factors which prompt or trigger specific innovations
whether socially based or otherwise are not are not mutually exclusive (Bason
2010) and in there is a complex and interacting relationship between a variety of
factors for any given innovation lsquoinstancersquo In addition there are well documented
factors which act to inhibit the development of innovative responses (see Crepaldi
et al 201215)
This work package has sought to identify generic criteria and drivers but it must be
recognised that the dynamics of individual settings and local factors will impact on
the actual processes of adoption
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
24
6 Conclusions and next steps
This report has presented the framework which has been used within the INNOSERV
project to support the choice of innovative case studies and to assist in identifying
the innovation phenomena potential and processes important to future research in
this area The framework has been used to select projects as case studies (see Work
Package 4 report Eurich and Strifler 2012) The framework interlinks aspects of
innovation (novelty type context improvement sustainability) with analysis of
challenges and changes which are acting as driving forces of innovation in social
services As the project is future facing it is proposed that key social challenges
and changes are likely to inform the development of new change paradigms for the
delivery of social services across Europe The framework will inform further
development and testing of concepts through the next stages of the INNOSERVE
programme This process will result in descriptions for the key areas in which future
research on innovation in social services should be taken forward
25
7 Bibliography
Bason C (2010) Leading public sector innovation Co-creating for a better society
Bristol The Policy Press
Bereiter C (2002) Design research for sustained innovation Cognitive Studies
Bulletin of the Japanese Cognitive Society 9 321-327
Christensen CM and Overdorf M (2000) Meeting the Challenge of Disruptive
Change Harvard Business Review March-April
Clark M and Goodwin N (2010) Sustaining innovation in telehealth and telecare
WSDNA briefing paper London The Kings Fund
Crepaldi C De Rosa E And Pesce F (2012) Literature review on innovation in
social services in Europe (sectors of Health Education and Welfare
Services)INNOSERV Work Package 1 report
Department of Health (2011) Innovation Health and Wealth Accelerating Adoption
and Diffusion in the NHS London Department of Health
Eurich J and Strifler A (2012) European compared selection of innovative social
services INNOSERV Work Package 4 report
Fuglsang L (2010) Bricolage and invisible innovation in public service innovation
Journal of Innovation Economics 5 67-87
Greenhalgh T Robert G Macfarlane F Bate P Kyriakidou O (2004) Diffusion of
innovations in service organizations systematic review and recommendations
Milbank Quarterly 82581-629
Hartley J (2005) Innovation in Governance and Public Services Past and Present
Public Money and Management 25127-34
Koch P and Hauknes J (2005) On innovation in the Public Sector Publin report no
D20
Kuhn T (1962) The Structure of Scientific Revolutions Chicago The University of
Chicago Press
Lakatos I and Musgrave A (eds) (1970) Criticism and the growth of knowledge
London Cambridge University Press
May
C Finch T Mair F et al ( 2007) Understanding the implementation of
complex interventions in health care the normalization process model BMC Health
Services Research 2007 7148 doi1011861472-6963-7-148
May et al (2009) Implementing Embedding and Integrating Practices An Outline of
Normalization Process Theory Sociology 43 535-554
Murray R Caulier-Grice J and Mulgan G (2010) The Open Book of Social
Innovation London The Young Foundation
26
OECD (2005) Oslo manual Guidelines for collecting and interpreting innovation
data 3rd
edition
Oliver M (1990) The politics of disablement Basingstoke Macmillan Education Ltd
Osborne S (1998) Naming the Beast Defining and Classifying Service Innovations
in Social Policy Human Relations 51 9 1133-1154
Osborne S and Brown K (2005) Managing Change and Innovation in Public Service
Organizations London Routledge
Phills JA Deiglmeier K and Miller DT (2008) Rediscovering Social Innovation
Stamford Innovation Review 6 4 34-43
Sullivan M (1987) Sociology and Social Welfare London Allen and Unwin
Tidd J and Bessant J (2009) Managing Innovation Integrating Technological
Market and organizational Change 4th
edition Chichester John Wiley and Sons
UK Government Department of Health (2011) Innovation Health and Wealth
Accelerating adoption and diffusion in the NHS London Department of Health
Wolfensburger W (1975) The principle of normalisation in human services Toronto
National Institute on Mental Retardation
27
8 Appendices
Appendix 1 Summary of types and criteria of innovation used in Work Package
3 to identify practices
Identification of social service
Field(s) of service
Logic(s) of service
Self help or mutual aid logic Social care logic Multi-stakeholders logic Social
movements logic Combination
Activities of services delivered
Assistance for persons faced with personal challenges or crises (debt unemployment
drug addiction other) (Re)integration of persons into society (rehabilitation language
training for immigrants other) Services to the labour market (occupational training)
Social housing for disadvantaged groups Care (for the elderly children families )
Treatment and support of people with physical illnesses Treatment and support of
people with mental health problems Combination
Status of the provider organization
Public organization (governmental) Private organization ndash nonnot for profit Private
organization ndash profit Volunteer association Cooperative company or mutual company
Familyneighbourhood Civil society network Combination Other
Target group
Children Youngsters Elder people Unemployed people Poor people Immigrants
Disabled people People with chronic diseases ndash long-term health problems People with
acute or short term health problems No specific target group (eg territory-based social
services provision aiming at strengthen social ties) Combination Other
Size of the organization
Innovation
Type of innovation
New forms of organization resources hybridization new targeted actions new services
non-structural practices other
Innovative character
do the service practices appear to be something new in the field of social services
Origins of innovation
Supply side demand side broader operating factors
Impact on service performance
Effectiveness of service delivery
from user perspective cost effectivenesscapacity building sustainability of
innovation
Quality of provision
28
Socialization quality of life as judged by users and beneficiaries more inclusion
lower risk on exclusion participation of the user transition from institutional to
community based care
Potential wider effects
Promoting social and health equality sustainability new skills and jobs
increased social rights affordability of adequate and high quality health and long-
term care promotion of equality and non-discrimination equal access to adequate
provision
Transferability of innovations between national contexts
29
Appendix 2 levels of innovation identified within INNOSERV Work Package 2
literature review
Organizational level (policy organizational sectors)
New social services designed to face new needs or unmet needs
Search for new solutions to old needs new mechanisms or practices introduced in
preexisting
social services
to improve access to social services (ie more information increased
professionalism in
social work sector)
to guarantee entitlements (rights) for specific groups or minorities
to satisfy the demand for social services in a more complete and broad way
(holistic
approach)
to guarantee more participation and inclusion of citizens
New and increased Cross-Sectoral social services
Cross-Sectoral social services (ie teaching art to children while helping their mothers
for
job seeking and offering jobs for young artists)
Integrated care practices
Tearing down walls between sectors and the role of informal care
Sharing of knowledge
Better integration of Health and Social sector services
Territory based social services that contribute to the creation of training and job
opportunities for disadvantaged people
Solidarity-based social services
Social mediation for impaired and weakened people
Easy access to housing for poor families
New interfaces with clients
Logic(s) of service Self help or mutual aid logic Social care logic Multi-stakeholders
logic
Social movements logic
The development of the self-help sector
Actors New organizations (Cooperative society for social service provision ndashSCOP
Cooperative society as social enterprise with userrsquos involvement ndashSCIC)
New legal forms within structured public frameworks (Italy social cooperatives)
New provider organizations and existing organisations refashioned by new dynamics
New roles and relations among actors
New private organizations for profit and non-profit
Management style in the organization
Regulatory and legislative level
New architecture of the provision system
Socially responsible public contracts and social clauses (outsourcing)
Adherence to EU standards in transitional economies
Impact on institutional framework that shape innovation in social services
New arrangement between one or more government agencies andor external
organization
Organizational level ndash Connection and Cooperation (governance and partnership)
New networks and social movements established in order to design deliver and
finance
social services
Cooperation between sectors actors and different forms of provision
Cooperation between local actors
Increasing communication responsiveness
30
Utilizing connectivity and interdependencies
Modification of organizational systems (models of governance work organisation
number
of involved stakeholders in governance)
Public sector and local authorities as promoters of innovation and promoters of
crosssectoral
policy strategies
Third sector and user as promoters of innovation
Volunteer workers and initiatives launched by a group of citizens
Third sector and userrsquos engagement design (co-design and re-design services)
Joint decision process
Decision-making power not based on capital ownership
Employee and user driven innovation
Partnerships with users family carers and user organizations
Partnership between service users practitioners and academics
Community-based and participative health network in a local territory
Collaboration between public and volunteer organisations (NGOs) or between civil and
local
networks in collaboration with public organisations and social enterprises
New techniques for partnership building and functioning
Impact on social and power relations
Professional level (practitioners)
New practices in social work
Innovative tools (ie Theatre of the Oppressed) and the use of participated methods in
social
work (ie self-help group)
Networking
Individualised supports
New professional skills in social work
The use of informatics and new technologies in social work
Users
Participation and involvement of final users of services in designing delivering and
evaluating social services
Involvement of final users in promoting equality effectiveness and control and
adherence
to the needs of users
Conceptual Level (and value)
New models of society - Social goals participation user involvement community
benefit
New paradigms underlying a new social service concept or service delivery model (ie
new
inclusion paradigm active ageing)
Relationships and trust
Pursuing diversity
Better adjustment to usersrsquo needs more person centred support
More social services provision in less developed regions
New concept of accessibility of the service (ie for Roma families)
The concept of lsquoprogressive universalismrsquo
The Social Care Model
De-institutionalization and community care Improved home-based and community
services
Gender and diversity perspectives
Anti-discrimination and equality process
Increase of the level of recognition of social values objectives paradigms and goals
New models of interaction leading to social innovation processes
31
Public policy level (policy framework programs and social policies)
The new role of the system governance played by central (or local depending on
national
arrangements) government
Impact on public policies new public policy programme measure or intervention
Joint construction of a space for public action and redefinition of public governance
bodies
and methods
Innovative logics for public policies
Innovating the public sector
The new wide attention on anti stigma policies
E-government
Financial and economic sustainability level (and scaling-diffusion-transferability
of innovation)
New ways to overcome budgetary constraints
New approaches to acquire funding
The involvement of private investors
The introduction of special funds
The purchase of innovative practices by final users
Hybridization of resources (market redistribution and reciprocity resources)
New investment sources
Mobilising community resources taking full advantage of all endogenous resources
Improvement in efficiency and effectiveness
Financial and systemic sustainability Impact on the economy
Economic Environmental and Social Sustainability of Territory based social services
Financial tools necessary to territorial social initiatives and the way to unlock them
Capacity of spreading and diffusion
Evaluative level and attention for quality
Affordability availability and accessibility
New standards expected
New feedback loops from users and specialists
Social services of excellence as for quality efficiency and efficacy
New methods and creative tool-kits to strengthen and renew the quality of social care
services
Low-cost (for user) and high level quality of social services
Quality assurance moderation and accreditation mechanisms
New tools for monitoring social services - hearing all voices (users organizations
practioners staff family and friends)
Action research
Alternative economic and social indicators
Social impact and contribution of innovation in social services to social innovation and
social change ndash Assessment of innovation
Learning approach to evaluation ndash lsquoto learn from failuresrsquo
Developmental evaluation
Specifics for the Health sector
Disability from rehabilitation to integration and then to inclusion
Mental Health from segregation to inclusion and community care
HIV from segregationstigmatization to awareness campaigns for promoting self
protection
Innovation in the area of prevention of treatment and in the introduction of new
technologies
Emphasis on an inter-sectoral controlled and steered care in managed care models
replacement of the traditional insurance model
Integrated services
Technological progress
32
Specifics for the Education sector
Inclusive education
Inclusive education and training in collaboration with the civil society
Multicultural education
Integration of disciplines
Alternative schools non-regular schools and informal education
Link between formal and informal education
Community development based approaches
Connection between regular school and the system of social services
Experiential learning
Human rights education
Working lsquothrough relationshipsrsquo with children and young people
Problem based learning methodology
The lsquomedia educationrsquo The use of comics
ICT in schools
E-inclusion
Networks of schools
Improve supplement reinvent and transform learning
Sustained educational improvement
Learning Beyond the Classroom
Spreading a culture that values learning
More personalized approaches to learning
Using the web
Learning with and by not to and from
33
Appendix 3 analysis of social challenges and changes driving innovation
Welfare
Societal
change as
driving force
of innovation
in social
services
Meaning
description
Related
outcomesother
factors
Examples of innovative
responses
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
Empowerment self-
determination choice
The lsquoassertive userrsquo
Demand for more
individualised services of
better quality
Alternativecomplementary
providers
Personalisation
Co-production (new
userprofessional
relationships)
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demand on services
Potential for poor access
to services (from
communication
problems social
isolation)
Multiculturalism
Integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Declining female
caregiving
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
34
Increased demand for
services demand for
formal care
Continued
inequality
Continued
economic
inequality
unemployment
continued poverty
including child
poverty continued
institutionalisation
continued
inequality for
people with
disabilities ethnic
minorities gender
inequalities
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients
with complex
comorbidities increase
in certain diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing demand for
services Increasing
costsneed to make
limited resources go
further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
Decisions about value
marketization
Technological
development
Access to
information new
media technology
Facilitates self
determination increases
expectations and choice
population better
informed about
conditionsservicesright
s and less deferential
Users better able to
35
mobilise
Increased exclusion of
some groups with limited
access
New models of remote
care provision
Ability to exchange
information on quality
and experience
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Increasing costs
Decisions about value
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Organisational
change changing
management
styles
philosophies
Creating new
organisational
forms application
of more responsive
management
processes
performance
management
culture
Integration of
organisationsfunctions
new approaches to
lsquocommissioningrsquo of
organisationsservices
distortions caused by
lsquolocked inrsquo expenditures
(tertiary health care
residential care)
Decentralisation
deinstitutionalisation
marketization liberalisation
The lsquoenabling
statersquo Political
will fiscal space
Impact of financial
crisis competing
priorities for public
funds
Legacy of category-based
(not needs based) social
protection structural
transition
deindustrialisation
Health
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
EmpowermentSelf-
determination choice
Demand for more
individualised services of
better quality
Users better able to mobilise
Assertive lsquouserrsquo
knowledgeable patient
Alternativecomplimentary
providers
36
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demands on
services
Potential for poor access
to services (from
communication
problems social
isolation)
MulticulturalismTrained
health professionals
move to richer countries
integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Declining female
caregiving
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
Increased demand for
formal care services
Continued
inequalities
Unequal
distribution of
health risks and
health
outcomediseases
by socioeconomic
indicators
Unequal access to
care by social
status geography
gender and
ethnicity
Demographic Increase in
numbers of over
Increase in patients with
complex comorbidities
Increasing demand for care
Decisions about value Active
37
change 65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing costsneed to
make limited resources
go further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
ageing paradigm
Technological
development
Access to
information new
media technology
Self determination
expectations choice
population better
informed about
conditionsservicesright
s and less deferential
Ability to exchange
information on quality
and experience
New models of care provision
(eg telehealth care) new
health management systems
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Changing
management
stylesphilosophi
es
Application of
more responsive
management
processes
Decentralisation
deinstitutionalisation
marketization liberalisation
Lifestyle changes Increase in certain
diseases related to
obesity alcohol
and drug
Increasing
costsdemands for care
38
consumption and
stress diabetes
liver disease
anxiety and
depression
Education
Aspirations Rising expectations
by citizens for
better quality of
life
Self determination
choice consumerism
Education outside of formal
setting
Assertive user
Lifelong learningeducation
Migration Historical (post
colonial) migration
pan-EU migration
refugees
New needs for education
eg language and culture
Inequalities social
fragmentation
Social Roles Changing family
structure increase
in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
changing gender
roles rising
female
employment rates
Need to reconcile work
and family life
Parentingfamily skills
for vulnerable
parentsfamilies
Socialization of children
ndash social and emotional
deficits for children in
some environments
Work with families and
communities
Continued
inequalities
Inequality in
educational
accessattainment
by socioeconomic
status gender
people with
disabilities ethnic
minorities
Culture of failure
Promise to deliver social
mobility and economic
improvement
(Leadbeater and Wond
2010 pp 5-20)
Inclusive and multicultural
education
Differential support for
children from
lsquodisadvantagedrsquo
backgrounds
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients with
complex comorbidities
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
New group of older
39
learners
Technological
advance
Access to
information new
media technology
making learning
available in new
ways
Self determination
expectations choice
lsquoAssertive userrsquo
Increased exclusion of
some groups with limited
access
Changing
management
styles
philosophies
Community based models
Globalization Need to provide
educationtraining
which is suited to
modern knowledge
based global
economies
This report for the InnoServ project (grant agreement nr 290542) is supported
under the Socio-economic and Humanities Programme of FP7
Chris Hawker
Faculty of Health Sciences University of Southampton Building 67 University Road Highfield Campus Southampton SO17 1BJ
Tel +44 (0)23 8059 7968
Email CHawkersotonacuk
9
Following the review of these work packages the key elements of innovation for the
INNOSERV project were identified as
relevance to current and future societal challenges
type of innovation response
novelty
improvement
sustainability
context of innovation
These elements were incorporated into the INNOSERV criteria framework developed
to link these key innovation elements together The framework is shown in box 2
Box 2 The INNOSERV criteria framework linking aspects of innovation
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
10
The core of the framework focuses on the ways in which key innovations respond to
drivers and challenges It links distinct types of innovation criteria First there are
those criteria which together define innovation type of innovation or response
novelty and hallmarks of innovation including context improvement and
sustainability Linked to these are drivers or key societal challenges driving
change in social services and other challenges prompting innovation
The remaining sections of this report provide a rationale and explanation of each of
these five separate aspects that make up the framework along with definitions and
explanations of the individual elements within each to provide an analysis against
which the remaining developmental phases of the Innoserv programme can be
assessed
31 Innovation responses innovation in practice
The INNOSERV Work Package 1 literature review and collection of examples has
helped to explicate innovation operating at different lsquolevelsrsquo within service systems
The levels identified in the literature review are shown in summary form in Box 3
and are provided in full including examples in appendix 2
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
11
From this five types of response are detailed within the INNOSERV criteria
framework new service new form of delivery new form of governance new form of
resourcing and new way of evaluation The meaning of these five levels is provided
in table 1 and examples are given to illustrate this It should be noted that the
levels of response are not necessarily exclusive and a specific practice innovation
may fall into more than one category
Box 3 identified levels of innovation in social services
organizational level (ie organization of the provision of social services
type of service target group delivering logics)
regulatory and legislative level (lsquohow services are regulated organised
provided and financed the modalities of service provision the types of
relationships between external service providers and public authoritiesrsquo
EC 2006 p 8)
organizational level ndash connection and cooperation (partnership
networks governance)
professional level (social work methods and practices) -
users level
conceptual level and values
public policy level (policy framework programs and social policies)
financial and economic sustainability level (and scaling-diffusion-
transferability of innovation)
evaluative level and attention to quality (quality standards)
Crepaldi et al 2012 98-99
12
Table 1 Levels of response
Response Definition Example
New service New or improved
product of the scheme
or process
Personalised instead of
generic service
New form of delivery New or improved means
by which the outcome is
achieved
Self-help or social enterprise
instead of government agency
New form of
governance
New or improved way
the scheme or process is
managed and where it
draws authority from
Co-operative or user managed
instead of public service
New form of
resourcing
New or improved
financial human or
physical inputs to the
scheme or process
Grant-funded collectively
staffed organisation instead of
professionally managed
government agency
New way of
evaluation
New or improved
parameters by which
success is judged
User assessment of
effectiveness instead or
professional determined
criteria
It is important to note that innovation within a service is more challenging to define
and measure than innovation in the sense of a product (OECD 2005) while a
product is a tangible entity innovation within service provision can be a either a
product or a process and can occur at different levels of service provision and there
are a number of potential complexities which may inform the structure set out in
table 1
Phills et al (2008) for instance state that social innovation can be
ldquoa product production process or technology (much like innovation in
general) but it can also be a principle an idea a piece of legislation a social
movement an intervention or some combination of themrdquo (39)
In discussing public sector services Hartley (2005) emphasises that innovation is
ldquonot just a new idea but a new practicerdquo (27) and argues therefore that definitions
need to recognise practical impact For services this impact might be at one of
several levels
The organisation literature on innovation offers the initial distinction between
product and process innovation to which other types of innovation have been
added such as position and paradigm innovation (Tidd and Bessant 2009) For
social service oriented innovation further types are added
For example Hartley (2005) identifies the levels of product service process
position strategic governance and rhetorical innovations Hochgerner (2011) adds
social types of innovation to include roles relations norms and values
13
Osborne and Brown (2005) critique a number of typologies to classify innovation
from the management literature They point out that the dichotomy between
process and outcome makes them alternatives whereas an innovation and
particularly innovation in services can be both With services there is often not a
distinct separation between product and process with production delivery and
consumption of services often occurring simultaneously (OECD 2005)
32 Novelty
The next aspect is innovation is novelty In terms of novelty a three way
categorisation is proposed for INNOSERV new perspectives on old needs or
problems new practices for old needs or problems a new practice for a new need
The categorisation reflects the need for innovation to address both existing needs
and new needs Again there is much discussion in the literature about novelty in
relation to innovation Two points are addressed which can be summarised as
lsquowhat degreelevel of novelty equates to innovationrsquo and lsquonew to whomrsquo
The first distinction to be made is between different levels of innovation
ldquoThere are degrees of noveltyrunning from minor incremental
improvements right through to radical changes which transform the way we
think about and use them Sometimes these changes are common to a
particular sector or activity but sometimes they are so radical and far-
reaching that they change the basis of societyhelliprdquo (Tidd and Bessant 2009
27)
Tidd and Bessant usefully break down the incremental-radical continuum as lsquodoing
what we do betterrsquo lsquonew to the enterprisersquo and lsquonew to the worldrsquo (Tidd and
Bessant 2009 38)
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
14
While for some writers a change must be radical or pattern breaking in order to be
innovation it has been argued that within services innovation can be small
adjustments (Fuglsang 2010) Fuglsang in fact argues for a view of innovation in
public sector services as a process of building of skills and expanding routines (68)
The second part of the argument lsquonew to whomrsquo is whether innovation relates to
absolute first use A common to view of innovation is not just those elements
developed within an institution but also those adopted from others (for example
see OECD (2005) for business sector innovation Phills et al (2008) regarding social
innovation Hartley (2005) and Koch (2005) in relation to innovation in public
services) Phills et al (2008) for example state
ldquoAlthough innovations need not necessarily be original they must be new to
the user context or applicationrdquo (Phills et al 37)
Osborne and Brown (2005) purport that most studies consider newness as new to a
person organisation society or situation but not necessarily first use (2005 120)
The authors go on to argue that these are in fact different forms of innovation
differently termed as objective and subjective innovation (Kimberly 1981) or
intrinsic and extrinsic innovation (Downs and Mohr 1976)
Hartley (2005) expounds the dissemination and adaptation of innovation to other
contexts as particularly important for public sector services arguing that public
goals ldquocan be enhanced through collaborative arrangements to create share
transfer adapt and embed good practicerdquo (27) She terms this ldquorsquolateralrsquo innovationrdquo
(33) of good practice adoption and adaption
An example of this approach to defining innovation within social services is seen in
the UK Government policy document on innovation within the National Health
Service which states
ldquoinnovation is as much about applying an idea service or product in a new
context or in a new organisation as it is about creating something newrdquo
(Department of Health 2011 9)
15
33 Hallmarks of innovation
Within social service systems it is not sufficient to focus only on novelty as a
marker of innovation In addition the INNOSERV framework includes certain
hallmarks of innovation including assessment of context quality and sustainability
331 Contextual fit
Different innovative approaches need to fit within different service framework
contexts and need adaptation to those contexts Drawing further on the above
discussion of novelty INNOSERV employ this to mean new to a given (for example
national) context This will reflect the diversity of social service contexts within the
European Union Case studies will also consider transferability of an innovation
from one context to another
332 Improvement in quality
ldquoIn public servicesinnovation is justifiable only where it increases public
value in the quality efficiency or fitness for purpose of governance or
servicesrdquo (Hartley 2005 30)
It is commonly understood that innovation is about improvement as well as novelty
Hartley (2005) offers a model which sets out the possible relationships between
innovation and improvement These relationships are for organisations showing no
improvement and no innovation improvement but no innovation innovation but no
improvement innovation and improvement Important points to highlight from this
model relate to innovation but no improvement first that innovations may not
always lead to success and a level of failure is to be expected second that
innovation can lead to increased but undesired choice loss of performance due to
the process of learning and innovations that are ultimately of no value In terms of
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
16
what is to be measured as improvement Hartley maintains that beyond
improvements in service quality and fitness for purpose wider issues of public
value should be considered
The difficulties of measurement and evaluation of innovation in social services need
to be highlighted as the measures of success within a social project are difficult to
define (Bason 2010 Murray et al 2010) Improvement of social services can
include improved quality of life and access to economic and social opportunity
These issues may relate differently in the fields of health welfare and education
For instance quality of life within health may relate to physical health and mental
wellbeing at different stages of life within welfare issues such as equality of access
to housing cultural and community activities and employment are important
The INNOSERV case studies will include available information on the outcomes of
the innovative project although these will likely vary in terms of types of
measurement used by the projects
333 Sustainability
ldquoInnovation is not just about the originating idea but also the whole process
of the successful development implementation and spread of that idea into
widespread userdquo (Department of Health 2011)
It is recognised that change through innovation needs to be sustainable (Bereiter
2002) Achieving a sustainable innovation may involve streamlining of ideas and
altering them to work in everyday practice (Murray et al 2010 12) The
Normalisation Process Model offered by May and colleagues (May et al 2007 May
et al 2009) provides a theoretical explanation within the context of health care of
the processes through which interventions become embedded in practice and then
integrated and sustained
17
4 Drivers of innovation key societal changes
Innovation within social services needs to be relevant to key social challenges and
changes This relates to the purpose of social services in responding to pressing
social demands and societal needs It is therefore important for the INNOSERV
project to have an understanding of the key social challenges and changes driving
innovation to inform the lsquotheoretical trendsrsquo influencing future innovation
requirements As part of this work package we have therefore sought to identify
social challenges and changes which may act as driving forces of innovation and
shape the development of social service lsquoparadigmsrsquo and hence future social
change
Using a lsquoscenario planningrsquo methodology borrowed from management science can
help to test the limits to any paradigm and identify where new paradigm models
may be needed in the future This in turn should help to identify where future
research interests could be located to explore not just opportunities for innovation
within the current paradigm but also where socially driven change is creating new
opportunities (or indeed requirements) for social and social services innovation
Further these challenges feed into social service provision in terms of an imperative
to address new needs and level of need and issues of rising costs
The INNOSERV project undertook such a scenario planning process the outcomes
of which inform what follows here Using an extended literature study on future
social challenges in the European context a number of key factors promoting a
response from and requiring change in social services were identified Individual
partners made further analysis of the important social challenges within their own
national context The factors were synthesised into a table of key social challenges
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
18
(see appendix 3) separately for health welfare and education sectors although
there was much overlap in the challenges relating to each sector
Small groups involving two country based teams in each case took each social
challenge and considered how it may change and develop given current
understandings of the forces affecting change (some forces may promote change
and some may block change) These were considered against potential political
developments economic developments socialsociological change technological
development legallegislative changes and environmental factors with a focus on
volume nature depth timeframe and scale of importance in influencing future
developments in social services
This work informed extensive discussion at the INNOSERV June 2012 Consortium
meeting with regard to the impact of key future developments on innovation and
the choice of projects which should be used to test key innovation developments
and their relevance to future service development
Relevance is represented in the INNOSERV criteria framework by the lsquodriversrsquo box
which includes a number of examples The most significant social challenges and
changes which were identified by the Consortium as most pertinent to innovation in
social services are listed in table 2 (page 19) and are explored further in the
remainder of this section The selection of projects as case studies has included
analysis of which of these social challenges and changes are being addressed (see
Work Package 4 report Eurich and Strifler 2012)
41 Demographic change as a key societal change driving innovation in the
health and welfare social service sectors
Demographic change was identified as a driving force of innovation in both health
and welfare services in Europe Current demographic change is resulting in
increased numbers of people living longer into old age with a particular increase in
the numbers of people aged over 80 This is alongside a reduction in the numbers
of people of working age in part due to a declining birth rate Further socio-cultural
change is leading to concerns about levels of informal care for older people
While many people will want to live active lives in old age some will live with long
periods of ill health and will have complex care needs resulting from multiple co-
morbidities Most however prefer to live as independently as possible
Questions arise about the ability to meet these increasing care demands from
declining tax income bases In addition the specific needs of elderly patients with
dementia represent a unique challenge for nursing staff and the organisation of
nursing services Financing of the rising health care costs for public agencies or for
health insurance schemes requires sustainable solutions and structural reforms
Traditional models of hospital lsquoacutersquo care may not necessarily be appropriate for
meeting these health care needs
This all highlights the need to find alternative solutions to care needs including the
use of technology and reliance on informal carers Current responses which are
relevant to this driver include integration of health and social care services to
increase cost efficiencies use of technological solutions to enhance self care and
care at home and new paradigms such as Active Ageing
19
Table 2 Key social challenges and changes driving innovation
Social
challengesocial
change driving
innovation
Meaning Social service sector
in which driver is key
Demographic
change
Increase in numbers of over 65s Greatest
increase in over 80 age group Increase in
old age dependency ratio
Health sector
Welfare sector
Aspirations Rising expectations of citizens for better
quality of lifebetter care
Health sector
Education sector
Cross sector services of
education and health
Lifestyles Increase in certain diseases related to
obesity alcohol and drug consumption
and stress diabetes liver disease anxiety
and depression
Health sector
Cross sector services of
education and health
Technology Access to information new media
technology
Health sector
Continued
inequalities
Continued economic inequality
unemployment continued poverty
including child poverty continued
institutionalisation continued inequality for
people with disabilities ethnic minorities
gender inequalities impact of socio-
economic status on health outcomes
Welfare sector
Education sector
Cross sector services of
education and health
and welfare and
education
Independent living The approach now adopted by disabled
people to live as ordinary members of
society and in their chosen domestic
setting
Welfare sector
Social roles Changing families increase in single
households increase in single parent
families changing generational relations
(due to longer life expectancy) reduction in
extended families
Changing gender roles rising female
employment rates
Welfare sector
Education sector
Organisational
changes
Creating new organisational forms
application of more responsive
management processes performance
management culture
Welfare sector
Changing
management
styles
Application of more responsive
management processes
Education sector
Cross sector services of
education and health
20
42 Aspirations as a key societal change driving innovation for health and
for education service sectors
Citizen aspirations were identified as a key societal change acting as a driving force
for innovation within both the health and education sectors and across the
boundary of these sectors Across Europe citizens are expecting a better quality of
life including improved outcomes from health and care services and reduced
inequalities
In terms of the health service sector this both derives from and manifests itself in
a population which is more informed about health issues Consequently patients
wish to be more involved in decisions about their health and their health care
options and are more willing and able to participate in the management of their
condition There is less deference to the medical profession and greater willingness
to make demands on health services There are a growing number of patient led
movements which are challenging some medical traditions
This aspect is fundamental both to everyday practice and to the future development
trajectory for health care services While most health aspirations are limited by
current knowledge and medical skill as research and medical advance offer new
choices and opportunities but at greater costs there will be difficult questions for
political debate This could well result in very different more personalised and
lsquopatient managedrsquo models of health care support
In terms of the education service sector individualism and the connected
aspiration of lsquobeing involvedrsquo has been an increasing trend over the past years and
is expected to keep gaining importance This is not only reflected by agendas of
individually shaped curricula or learning arrangements in school but also by the
opening of the public (ie government funded) school system towards involvement
of the community (seniors in school corporate sponsoring external initiatives of
informal learning and personality formation etc) This is reflected in a similar way
in higher education (eg service learning) and adult education (lsquolearning regionsrsquo)
Across the boundary of health and education aspirations coupled with medical
advance lead to a desire for independence of disabled people and those with long
term conditions This highlights the need for health programs focussed on self
esteem
43 Lifestyles as a key societal challenge driving innovation in the health
service sector and also in the cross sector services of health and education
A key social challenge acting as a driving force for innovation for the health sector
and in the cross sector services of education and health is a recognised growth in
lsquolifestylersquo related conditions arising from unhealthy behaviours such as poor diet
alcohol consumption and smoking (although there is limited evidence of a decline
in smoking rates as its harmful effects are less well tolerated) Political investment
in public health is recognised as an important strategic ambition but often not
matched by financial resources Questions about personal responsibility are also
being asked with suggestions that people with poor health behaviours should not
be given the same priority to responsive health care services As other factors
impacting on health outcomes become more responsive to medical advance these
factors are growing in importance in their impact both on wider society and in
improving overall health outcomes
21
44 Technology as a key societal change driving innovation in the health
service sector
The growth in internet and web based technology is leading to an exponential
growth in access to information and new forms of communication More people
now use the internet as their primary health care information resource Web
lsquocommunitiesrsquo are linking and thus empowering people faced with similar health
challenges Telehealthcare solutions to on-going care needs are becoming more
widely available and are changing the patterns of demands for some health care
services Other new technologies for example in transport and in home assistance
devices are enabling greater independence for disabled people
As future generations use and expect more from access to information and
communication services health care services will have to respond to both the
demands and the opportunities created by such technology Technology can be
seen as both a driving force for innovation and as an enabler of change
45 Continued inequalities as a key societal challenge driving innovation in
welfare and education service sectors also in cross sector services of
education and health and welfare and education
Continued inequalities were identified as a key driving force for innovation within
both welfare and education sectors and in services which straddle the boundary
between education and health services and education and welfare services
Inequalities stem from issues of migration social originbackground
unemployment disability and gender and have been a source of the social
upheaval which has been seen in Europe in recent months
Within health education the link between socio-economic status and health is clear
with people from lower socio-economic groups experiencing poorer health and less
likely engaging in health promoting behaviours In the case of migrants health
messages need to be delivered in a culturally appropriate manner
46 Independent living as a key societal change driving innovation in the
welfare service sector
In terms of disability the emergence and spread of the independent living
philosophy has been a key change driving innovation in the welfare service sector
Typically innovation in this field involves new stakeholder roles with a much more
proactive role for service users in all stages of service provision design
implementation monitoring and fine tuning of services as well as a role in
coordination of different entitlementsservices andor administration and reporting
requirements The boundaries are being pushed further deeper and wider every
day Starting from persons with physical disabilities services are now promoting
active involvement of persons with severe mental disabilities a development that
was deemed impossible only 30 years ago
47 Social roles as a key societal change driving innovation for welfare and
for education service sectors
Changing social roles were identified as a key challenge driving innovation within
the welfare and education sectors These changes are within families and of the
family itself and include changing gender roles and changing family structures (eg
increase in single parent families increase in the numbers of older people living
alone) Families seem to be becoming a sphere of public or community interest
rather than an exclusively private one
Proper lsquosocializationrsquo of children is the key to building viable and sustainable
futures for individuals Early stage family intervention is necessary to prevent the
22
very emergence of conflicts lsquoExternalrsquo interventions often do not reach every day
interaction and thus the root causes of problems This is of significance for family
based projects as well as for care institutions and education providers
48 Organisational changes as a key societal change driving innovation in
welfare service sectors
The shifting of provision of services from the public sector into other sectors such
as independent profit making companies and social enterprises creates new
opportunities for innovation In addition there is an increasing move to provide
services locally in order to be more relevant and responsive and a move to
community based models of care
49 Changing management styles as a key innovation challenge for the
education service sector and in cross sector services of the health and
education sector
Connected to individualism as well as new social roles of individuals family
community and institutions management styles shaped by multi-stakeholder
involvement are gaining importance Community based models do not only increase
the complexity of players involved in the lsquovalue creationrsquo process but also the
enhancement of skill development and personality formation as well as the
fertilization of the educational landscape by innovative ideas expertise and
practices of diverse partners The latter fact also stimulates an increase in cross-
sectoral services (education health and social services) Simultaneously this
situation increases the necessity to spot choose and foster the lsquoinfluencesrsquo and
lsquocombinationsrsquo which realize the highest value through the assessment of social
impact
Increased emphasis is also being placed on illustrating and monitoring
performance Impact measurement and associated tools and practices gain
overarching importance
In terms of changing management styles within the health and education sector an
important aspect is the cooperation of different stakeholders and the involvement
of the community or userrsquos perspective Linked to increased user aspirations
people would like to take part in the development of programs and services With
their special knowledge of their condition for example they can contribute their
expertise within social services
23
5 Other key challenges driving innovation
Sociatal challenges and changes are of course only one driving force of innovation
In addition to these there are other meso and micro level factors which also drive
innovation These include research and development leading to new knowledge
professionally led innovation in response to users needs increasing costs of service
provision and demands for greater efficiency per se and specific political contexts
These other forces are included in the INNOSERV criteria framework in the
lsquochallengesrsquo box These factors are not a key focus for selection of projects for
INNOSERV as they are often very situation specific but will be noted in the case
studies where relevant The factors which prompt or trigger specific innovations
whether socially based or otherwise are not are not mutually exclusive (Bason
2010) and in there is a complex and interacting relationship between a variety of
factors for any given innovation lsquoinstancersquo In addition there are well documented
factors which act to inhibit the development of innovative responses (see Crepaldi
et al 201215)
This work package has sought to identify generic criteria and drivers but it must be
recognised that the dynamics of individual settings and local factors will impact on
the actual processes of adoption
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
24
6 Conclusions and next steps
This report has presented the framework which has been used within the INNOSERV
project to support the choice of innovative case studies and to assist in identifying
the innovation phenomena potential and processes important to future research in
this area The framework has been used to select projects as case studies (see Work
Package 4 report Eurich and Strifler 2012) The framework interlinks aspects of
innovation (novelty type context improvement sustainability) with analysis of
challenges and changes which are acting as driving forces of innovation in social
services As the project is future facing it is proposed that key social challenges
and changes are likely to inform the development of new change paradigms for the
delivery of social services across Europe The framework will inform further
development and testing of concepts through the next stages of the INNOSERVE
programme This process will result in descriptions for the key areas in which future
research on innovation in social services should be taken forward
25
7 Bibliography
Bason C (2010) Leading public sector innovation Co-creating for a better society
Bristol The Policy Press
Bereiter C (2002) Design research for sustained innovation Cognitive Studies
Bulletin of the Japanese Cognitive Society 9 321-327
Christensen CM and Overdorf M (2000) Meeting the Challenge of Disruptive
Change Harvard Business Review March-April
Clark M and Goodwin N (2010) Sustaining innovation in telehealth and telecare
WSDNA briefing paper London The Kings Fund
Crepaldi C De Rosa E And Pesce F (2012) Literature review on innovation in
social services in Europe (sectors of Health Education and Welfare
Services)INNOSERV Work Package 1 report
Department of Health (2011) Innovation Health and Wealth Accelerating Adoption
and Diffusion in the NHS London Department of Health
Eurich J and Strifler A (2012) European compared selection of innovative social
services INNOSERV Work Package 4 report
Fuglsang L (2010) Bricolage and invisible innovation in public service innovation
Journal of Innovation Economics 5 67-87
Greenhalgh T Robert G Macfarlane F Bate P Kyriakidou O (2004) Diffusion of
innovations in service organizations systematic review and recommendations
Milbank Quarterly 82581-629
Hartley J (2005) Innovation in Governance and Public Services Past and Present
Public Money and Management 25127-34
Koch P and Hauknes J (2005) On innovation in the Public Sector Publin report no
D20
Kuhn T (1962) The Structure of Scientific Revolutions Chicago The University of
Chicago Press
Lakatos I and Musgrave A (eds) (1970) Criticism and the growth of knowledge
London Cambridge University Press
May
C Finch T Mair F et al ( 2007) Understanding the implementation of
complex interventions in health care the normalization process model BMC Health
Services Research 2007 7148 doi1011861472-6963-7-148
May et al (2009) Implementing Embedding and Integrating Practices An Outline of
Normalization Process Theory Sociology 43 535-554
Murray R Caulier-Grice J and Mulgan G (2010) The Open Book of Social
Innovation London The Young Foundation
26
OECD (2005) Oslo manual Guidelines for collecting and interpreting innovation
data 3rd
edition
Oliver M (1990) The politics of disablement Basingstoke Macmillan Education Ltd
Osborne S (1998) Naming the Beast Defining and Classifying Service Innovations
in Social Policy Human Relations 51 9 1133-1154
Osborne S and Brown K (2005) Managing Change and Innovation in Public Service
Organizations London Routledge
Phills JA Deiglmeier K and Miller DT (2008) Rediscovering Social Innovation
Stamford Innovation Review 6 4 34-43
Sullivan M (1987) Sociology and Social Welfare London Allen and Unwin
Tidd J and Bessant J (2009) Managing Innovation Integrating Technological
Market and organizational Change 4th
edition Chichester John Wiley and Sons
UK Government Department of Health (2011) Innovation Health and Wealth
Accelerating adoption and diffusion in the NHS London Department of Health
Wolfensburger W (1975) The principle of normalisation in human services Toronto
National Institute on Mental Retardation
27
8 Appendices
Appendix 1 Summary of types and criteria of innovation used in Work Package
3 to identify practices
Identification of social service
Field(s) of service
Logic(s) of service
Self help or mutual aid logic Social care logic Multi-stakeholders logic Social
movements logic Combination
Activities of services delivered
Assistance for persons faced with personal challenges or crises (debt unemployment
drug addiction other) (Re)integration of persons into society (rehabilitation language
training for immigrants other) Services to the labour market (occupational training)
Social housing for disadvantaged groups Care (for the elderly children families )
Treatment and support of people with physical illnesses Treatment and support of
people with mental health problems Combination
Status of the provider organization
Public organization (governmental) Private organization ndash nonnot for profit Private
organization ndash profit Volunteer association Cooperative company or mutual company
Familyneighbourhood Civil society network Combination Other
Target group
Children Youngsters Elder people Unemployed people Poor people Immigrants
Disabled people People with chronic diseases ndash long-term health problems People with
acute or short term health problems No specific target group (eg territory-based social
services provision aiming at strengthen social ties) Combination Other
Size of the organization
Innovation
Type of innovation
New forms of organization resources hybridization new targeted actions new services
non-structural practices other
Innovative character
do the service practices appear to be something new in the field of social services
Origins of innovation
Supply side demand side broader operating factors
Impact on service performance
Effectiveness of service delivery
from user perspective cost effectivenesscapacity building sustainability of
innovation
Quality of provision
28
Socialization quality of life as judged by users and beneficiaries more inclusion
lower risk on exclusion participation of the user transition from institutional to
community based care
Potential wider effects
Promoting social and health equality sustainability new skills and jobs
increased social rights affordability of adequate and high quality health and long-
term care promotion of equality and non-discrimination equal access to adequate
provision
Transferability of innovations between national contexts
29
Appendix 2 levels of innovation identified within INNOSERV Work Package 2
literature review
Organizational level (policy organizational sectors)
New social services designed to face new needs or unmet needs
Search for new solutions to old needs new mechanisms or practices introduced in
preexisting
social services
to improve access to social services (ie more information increased
professionalism in
social work sector)
to guarantee entitlements (rights) for specific groups or minorities
to satisfy the demand for social services in a more complete and broad way
(holistic
approach)
to guarantee more participation and inclusion of citizens
New and increased Cross-Sectoral social services
Cross-Sectoral social services (ie teaching art to children while helping their mothers
for
job seeking and offering jobs for young artists)
Integrated care practices
Tearing down walls between sectors and the role of informal care
Sharing of knowledge
Better integration of Health and Social sector services
Territory based social services that contribute to the creation of training and job
opportunities for disadvantaged people
Solidarity-based social services
Social mediation for impaired and weakened people
Easy access to housing for poor families
New interfaces with clients
Logic(s) of service Self help or mutual aid logic Social care logic Multi-stakeholders
logic
Social movements logic
The development of the self-help sector
Actors New organizations (Cooperative society for social service provision ndashSCOP
Cooperative society as social enterprise with userrsquos involvement ndashSCIC)
New legal forms within structured public frameworks (Italy social cooperatives)
New provider organizations and existing organisations refashioned by new dynamics
New roles and relations among actors
New private organizations for profit and non-profit
Management style in the organization
Regulatory and legislative level
New architecture of the provision system
Socially responsible public contracts and social clauses (outsourcing)
Adherence to EU standards in transitional economies
Impact on institutional framework that shape innovation in social services
New arrangement between one or more government agencies andor external
organization
Organizational level ndash Connection and Cooperation (governance and partnership)
New networks and social movements established in order to design deliver and
finance
social services
Cooperation between sectors actors and different forms of provision
Cooperation between local actors
Increasing communication responsiveness
30
Utilizing connectivity and interdependencies
Modification of organizational systems (models of governance work organisation
number
of involved stakeholders in governance)
Public sector and local authorities as promoters of innovation and promoters of
crosssectoral
policy strategies
Third sector and user as promoters of innovation
Volunteer workers and initiatives launched by a group of citizens
Third sector and userrsquos engagement design (co-design and re-design services)
Joint decision process
Decision-making power not based on capital ownership
Employee and user driven innovation
Partnerships with users family carers and user organizations
Partnership between service users practitioners and academics
Community-based and participative health network in a local territory
Collaboration between public and volunteer organisations (NGOs) or between civil and
local
networks in collaboration with public organisations and social enterprises
New techniques for partnership building and functioning
Impact on social and power relations
Professional level (practitioners)
New practices in social work
Innovative tools (ie Theatre of the Oppressed) and the use of participated methods in
social
work (ie self-help group)
Networking
Individualised supports
New professional skills in social work
The use of informatics and new technologies in social work
Users
Participation and involvement of final users of services in designing delivering and
evaluating social services
Involvement of final users in promoting equality effectiveness and control and
adherence
to the needs of users
Conceptual Level (and value)
New models of society - Social goals participation user involvement community
benefit
New paradigms underlying a new social service concept or service delivery model (ie
new
inclusion paradigm active ageing)
Relationships and trust
Pursuing diversity
Better adjustment to usersrsquo needs more person centred support
More social services provision in less developed regions
New concept of accessibility of the service (ie for Roma families)
The concept of lsquoprogressive universalismrsquo
The Social Care Model
De-institutionalization and community care Improved home-based and community
services
Gender and diversity perspectives
Anti-discrimination and equality process
Increase of the level of recognition of social values objectives paradigms and goals
New models of interaction leading to social innovation processes
31
Public policy level (policy framework programs and social policies)
The new role of the system governance played by central (or local depending on
national
arrangements) government
Impact on public policies new public policy programme measure or intervention
Joint construction of a space for public action and redefinition of public governance
bodies
and methods
Innovative logics for public policies
Innovating the public sector
The new wide attention on anti stigma policies
E-government
Financial and economic sustainability level (and scaling-diffusion-transferability
of innovation)
New ways to overcome budgetary constraints
New approaches to acquire funding
The involvement of private investors
The introduction of special funds
The purchase of innovative practices by final users
Hybridization of resources (market redistribution and reciprocity resources)
New investment sources
Mobilising community resources taking full advantage of all endogenous resources
Improvement in efficiency and effectiveness
Financial and systemic sustainability Impact on the economy
Economic Environmental and Social Sustainability of Territory based social services
Financial tools necessary to territorial social initiatives and the way to unlock them
Capacity of spreading and diffusion
Evaluative level and attention for quality
Affordability availability and accessibility
New standards expected
New feedback loops from users and specialists
Social services of excellence as for quality efficiency and efficacy
New methods and creative tool-kits to strengthen and renew the quality of social care
services
Low-cost (for user) and high level quality of social services
Quality assurance moderation and accreditation mechanisms
New tools for monitoring social services - hearing all voices (users organizations
practioners staff family and friends)
Action research
Alternative economic and social indicators
Social impact and contribution of innovation in social services to social innovation and
social change ndash Assessment of innovation
Learning approach to evaluation ndash lsquoto learn from failuresrsquo
Developmental evaluation
Specifics for the Health sector
Disability from rehabilitation to integration and then to inclusion
Mental Health from segregation to inclusion and community care
HIV from segregationstigmatization to awareness campaigns for promoting self
protection
Innovation in the area of prevention of treatment and in the introduction of new
technologies
Emphasis on an inter-sectoral controlled and steered care in managed care models
replacement of the traditional insurance model
Integrated services
Technological progress
32
Specifics for the Education sector
Inclusive education
Inclusive education and training in collaboration with the civil society
Multicultural education
Integration of disciplines
Alternative schools non-regular schools and informal education
Link between formal and informal education
Community development based approaches
Connection between regular school and the system of social services
Experiential learning
Human rights education
Working lsquothrough relationshipsrsquo with children and young people
Problem based learning methodology
The lsquomedia educationrsquo The use of comics
ICT in schools
E-inclusion
Networks of schools
Improve supplement reinvent and transform learning
Sustained educational improvement
Learning Beyond the Classroom
Spreading a culture that values learning
More personalized approaches to learning
Using the web
Learning with and by not to and from
33
Appendix 3 analysis of social challenges and changes driving innovation
Welfare
Societal
change as
driving force
of innovation
in social
services
Meaning
description
Related
outcomesother
factors
Examples of innovative
responses
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
Empowerment self-
determination choice
The lsquoassertive userrsquo
Demand for more
individualised services of
better quality
Alternativecomplementary
providers
Personalisation
Co-production (new
userprofessional
relationships)
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demand on services
Potential for poor access
to services (from
communication
problems social
isolation)
Multiculturalism
Integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Declining female
caregiving
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
34
Increased demand for
services demand for
formal care
Continued
inequality
Continued
economic
inequality
unemployment
continued poverty
including child
poverty continued
institutionalisation
continued
inequality for
people with
disabilities ethnic
minorities gender
inequalities
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients
with complex
comorbidities increase
in certain diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing demand for
services Increasing
costsneed to make
limited resources go
further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
Decisions about value
marketization
Technological
development
Access to
information new
media technology
Facilitates self
determination increases
expectations and choice
population better
informed about
conditionsservicesright
s and less deferential
Users better able to
35
mobilise
Increased exclusion of
some groups with limited
access
New models of remote
care provision
Ability to exchange
information on quality
and experience
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Increasing costs
Decisions about value
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Organisational
change changing
management
styles
philosophies
Creating new
organisational
forms application
of more responsive
management
processes
performance
management
culture
Integration of
organisationsfunctions
new approaches to
lsquocommissioningrsquo of
organisationsservices
distortions caused by
lsquolocked inrsquo expenditures
(tertiary health care
residential care)
Decentralisation
deinstitutionalisation
marketization liberalisation
The lsquoenabling
statersquo Political
will fiscal space
Impact of financial
crisis competing
priorities for public
funds
Legacy of category-based
(not needs based) social
protection structural
transition
deindustrialisation
Health
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
EmpowermentSelf-
determination choice
Demand for more
individualised services of
better quality
Users better able to mobilise
Assertive lsquouserrsquo
knowledgeable patient
Alternativecomplimentary
providers
36
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demands on
services
Potential for poor access
to services (from
communication
problems social
isolation)
MulticulturalismTrained
health professionals
move to richer countries
integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Declining female
caregiving
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
Increased demand for
formal care services
Continued
inequalities
Unequal
distribution of
health risks and
health
outcomediseases
by socioeconomic
indicators
Unequal access to
care by social
status geography
gender and
ethnicity
Demographic Increase in
numbers of over
Increase in patients with
complex comorbidities
Increasing demand for care
Decisions about value Active
37
change 65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing costsneed to
make limited resources
go further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
ageing paradigm
Technological
development
Access to
information new
media technology
Self determination
expectations choice
population better
informed about
conditionsservicesright
s and less deferential
Ability to exchange
information on quality
and experience
New models of care provision
(eg telehealth care) new
health management systems
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Changing
management
stylesphilosophi
es
Application of
more responsive
management
processes
Decentralisation
deinstitutionalisation
marketization liberalisation
Lifestyle changes Increase in certain
diseases related to
obesity alcohol
and drug
Increasing
costsdemands for care
38
consumption and
stress diabetes
liver disease
anxiety and
depression
Education
Aspirations Rising expectations
by citizens for
better quality of
life
Self determination
choice consumerism
Education outside of formal
setting
Assertive user
Lifelong learningeducation
Migration Historical (post
colonial) migration
pan-EU migration
refugees
New needs for education
eg language and culture
Inequalities social
fragmentation
Social Roles Changing family
structure increase
in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
changing gender
roles rising
female
employment rates
Need to reconcile work
and family life
Parentingfamily skills
for vulnerable
parentsfamilies
Socialization of children
ndash social and emotional
deficits for children in
some environments
Work with families and
communities
Continued
inequalities
Inequality in
educational
accessattainment
by socioeconomic
status gender
people with
disabilities ethnic
minorities
Culture of failure
Promise to deliver social
mobility and economic
improvement
(Leadbeater and Wond
2010 pp 5-20)
Inclusive and multicultural
education
Differential support for
children from
lsquodisadvantagedrsquo
backgrounds
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients with
complex comorbidities
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
New group of older
39
learners
Technological
advance
Access to
information new
media technology
making learning
available in new
ways
Self determination
expectations choice
lsquoAssertive userrsquo
Increased exclusion of
some groups with limited
access
Changing
management
styles
philosophies
Community based models
Globalization Need to provide
educationtraining
which is suited to
modern knowledge
based global
economies
This report for the InnoServ project (grant agreement nr 290542) is supported
under the Socio-economic and Humanities Programme of FP7
Chris Hawker
Faculty of Health Sciences University of Southampton Building 67 University Road Highfield Campus Southampton SO17 1BJ
Tel +44 (0)23 8059 7968
Email CHawkersotonacuk
10
The core of the framework focuses on the ways in which key innovations respond to
drivers and challenges It links distinct types of innovation criteria First there are
those criteria which together define innovation type of innovation or response
novelty and hallmarks of innovation including context improvement and
sustainability Linked to these are drivers or key societal challenges driving
change in social services and other challenges prompting innovation
The remaining sections of this report provide a rationale and explanation of each of
these five separate aspects that make up the framework along with definitions and
explanations of the individual elements within each to provide an analysis against
which the remaining developmental phases of the Innoserv programme can be
assessed
31 Innovation responses innovation in practice
The INNOSERV Work Package 1 literature review and collection of examples has
helped to explicate innovation operating at different lsquolevelsrsquo within service systems
The levels identified in the literature review are shown in summary form in Box 3
and are provided in full including examples in appendix 2
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
11
From this five types of response are detailed within the INNOSERV criteria
framework new service new form of delivery new form of governance new form of
resourcing and new way of evaluation The meaning of these five levels is provided
in table 1 and examples are given to illustrate this It should be noted that the
levels of response are not necessarily exclusive and a specific practice innovation
may fall into more than one category
Box 3 identified levels of innovation in social services
organizational level (ie organization of the provision of social services
type of service target group delivering logics)
regulatory and legislative level (lsquohow services are regulated organised
provided and financed the modalities of service provision the types of
relationships between external service providers and public authoritiesrsquo
EC 2006 p 8)
organizational level ndash connection and cooperation (partnership
networks governance)
professional level (social work methods and practices) -
users level
conceptual level and values
public policy level (policy framework programs and social policies)
financial and economic sustainability level (and scaling-diffusion-
transferability of innovation)
evaluative level and attention to quality (quality standards)
Crepaldi et al 2012 98-99
12
Table 1 Levels of response
Response Definition Example
New service New or improved
product of the scheme
or process
Personalised instead of
generic service
New form of delivery New or improved means
by which the outcome is
achieved
Self-help or social enterprise
instead of government agency
New form of
governance
New or improved way
the scheme or process is
managed and where it
draws authority from
Co-operative or user managed
instead of public service
New form of
resourcing
New or improved
financial human or
physical inputs to the
scheme or process
Grant-funded collectively
staffed organisation instead of
professionally managed
government agency
New way of
evaluation
New or improved
parameters by which
success is judged
User assessment of
effectiveness instead or
professional determined
criteria
It is important to note that innovation within a service is more challenging to define
and measure than innovation in the sense of a product (OECD 2005) while a
product is a tangible entity innovation within service provision can be a either a
product or a process and can occur at different levels of service provision and there
are a number of potential complexities which may inform the structure set out in
table 1
Phills et al (2008) for instance state that social innovation can be
ldquoa product production process or technology (much like innovation in
general) but it can also be a principle an idea a piece of legislation a social
movement an intervention or some combination of themrdquo (39)
In discussing public sector services Hartley (2005) emphasises that innovation is
ldquonot just a new idea but a new practicerdquo (27) and argues therefore that definitions
need to recognise practical impact For services this impact might be at one of
several levels
The organisation literature on innovation offers the initial distinction between
product and process innovation to which other types of innovation have been
added such as position and paradigm innovation (Tidd and Bessant 2009) For
social service oriented innovation further types are added
For example Hartley (2005) identifies the levels of product service process
position strategic governance and rhetorical innovations Hochgerner (2011) adds
social types of innovation to include roles relations norms and values
13
Osborne and Brown (2005) critique a number of typologies to classify innovation
from the management literature They point out that the dichotomy between
process and outcome makes them alternatives whereas an innovation and
particularly innovation in services can be both With services there is often not a
distinct separation between product and process with production delivery and
consumption of services often occurring simultaneously (OECD 2005)
32 Novelty
The next aspect is innovation is novelty In terms of novelty a three way
categorisation is proposed for INNOSERV new perspectives on old needs or
problems new practices for old needs or problems a new practice for a new need
The categorisation reflects the need for innovation to address both existing needs
and new needs Again there is much discussion in the literature about novelty in
relation to innovation Two points are addressed which can be summarised as
lsquowhat degreelevel of novelty equates to innovationrsquo and lsquonew to whomrsquo
The first distinction to be made is between different levels of innovation
ldquoThere are degrees of noveltyrunning from minor incremental
improvements right through to radical changes which transform the way we
think about and use them Sometimes these changes are common to a
particular sector or activity but sometimes they are so radical and far-
reaching that they change the basis of societyhelliprdquo (Tidd and Bessant 2009
27)
Tidd and Bessant usefully break down the incremental-radical continuum as lsquodoing
what we do betterrsquo lsquonew to the enterprisersquo and lsquonew to the worldrsquo (Tidd and
Bessant 2009 38)
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
14
While for some writers a change must be radical or pattern breaking in order to be
innovation it has been argued that within services innovation can be small
adjustments (Fuglsang 2010) Fuglsang in fact argues for a view of innovation in
public sector services as a process of building of skills and expanding routines (68)
The second part of the argument lsquonew to whomrsquo is whether innovation relates to
absolute first use A common to view of innovation is not just those elements
developed within an institution but also those adopted from others (for example
see OECD (2005) for business sector innovation Phills et al (2008) regarding social
innovation Hartley (2005) and Koch (2005) in relation to innovation in public
services) Phills et al (2008) for example state
ldquoAlthough innovations need not necessarily be original they must be new to
the user context or applicationrdquo (Phills et al 37)
Osborne and Brown (2005) purport that most studies consider newness as new to a
person organisation society or situation but not necessarily first use (2005 120)
The authors go on to argue that these are in fact different forms of innovation
differently termed as objective and subjective innovation (Kimberly 1981) or
intrinsic and extrinsic innovation (Downs and Mohr 1976)
Hartley (2005) expounds the dissemination and adaptation of innovation to other
contexts as particularly important for public sector services arguing that public
goals ldquocan be enhanced through collaborative arrangements to create share
transfer adapt and embed good practicerdquo (27) She terms this ldquorsquolateralrsquo innovationrdquo
(33) of good practice adoption and adaption
An example of this approach to defining innovation within social services is seen in
the UK Government policy document on innovation within the National Health
Service which states
ldquoinnovation is as much about applying an idea service or product in a new
context or in a new organisation as it is about creating something newrdquo
(Department of Health 2011 9)
15
33 Hallmarks of innovation
Within social service systems it is not sufficient to focus only on novelty as a
marker of innovation In addition the INNOSERV framework includes certain
hallmarks of innovation including assessment of context quality and sustainability
331 Contextual fit
Different innovative approaches need to fit within different service framework
contexts and need adaptation to those contexts Drawing further on the above
discussion of novelty INNOSERV employ this to mean new to a given (for example
national) context This will reflect the diversity of social service contexts within the
European Union Case studies will also consider transferability of an innovation
from one context to another
332 Improvement in quality
ldquoIn public servicesinnovation is justifiable only where it increases public
value in the quality efficiency or fitness for purpose of governance or
servicesrdquo (Hartley 2005 30)
It is commonly understood that innovation is about improvement as well as novelty
Hartley (2005) offers a model which sets out the possible relationships between
innovation and improvement These relationships are for organisations showing no
improvement and no innovation improvement but no innovation innovation but no
improvement innovation and improvement Important points to highlight from this
model relate to innovation but no improvement first that innovations may not
always lead to success and a level of failure is to be expected second that
innovation can lead to increased but undesired choice loss of performance due to
the process of learning and innovations that are ultimately of no value In terms of
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
16
what is to be measured as improvement Hartley maintains that beyond
improvements in service quality and fitness for purpose wider issues of public
value should be considered
The difficulties of measurement and evaluation of innovation in social services need
to be highlighted as the measures of success within a social project are difficult to
define (Bason 2010 Murray et al 2010) Improvement of social services can
include improved quality of life and access to economic and social opportunity
These issues may relate differently in the fields of health welfare and education
For instance quality of life within health may relate to physical health and mental
wellbeing at different stages of life within welfare issues such as equality of access
to housing cultural and community activities and employment are important
The INNOSERV case studies will include available information on the outcomes of
the innovative project although these will likely vary in terms of types of
measurement used by the projects
333 Sustainability
ldquoInnovation is not just about the originating idea but also the whole process
of the successful development implementation and spread of that idea into
widespread userdquo (Department of Health 2011)
It is recognised that change through innovation needs to be sustainable (Bereiter
2002) Achieving a sustainable innovation may involve streamlining of ideas and
altering them to work in everyday practice (Murray et al 2010 12) The
Normalisation Process Model offered by May and colleagues (May et al 2007 May
et al 2009) provides a theoretical explanation within the context of health care of
the processes through which interventions become embedded in practice and then
integrated and sustained
17
4 Drivers of innovation key societal changes
Innovation within social services needs to be relevant to key social challenges and
changes This relates to the purpose of social services in responding to pressing
social demands and societal needs It is therefore important for the INNOSERV
project to have an understanding of the key social challenges and changes driving
innovation to inform the lsquotheoretical trendsrsquo influencing future innovation
requirements As part of this work package we have therefore sought to identify
social challenges and changes which may act as driving forces of innovation and
shape the development of social service lsquoparadigmsrsquo and hence future social
change
Using a lsquoscenario planningrsquo methodology borrowed from management science can
help to test the limits to any paradigm and identify where new paradigm models
may be needed in the future This in turn should help to identify where future
research interests could be located to explore not just opportunities for innovation
within the current paradigm but also where socially driven change is creating new
opportunities (or indeed requirements) for social and social services innovation
Further these challenges feed into social service provision in terms of an imperative
to address new needs and level of need and issues of rising costs
The INNOSERV project undertook such a scenario planning process the outcomes
of which inform what follows here Using an extended literature study on future
social challenges in the European context a number of key factors promoting a
response from and requiring change in social services were identified Individual
partners made further analysis of the important social challenges within their own
national context The factors were synthesised into a table of key social challenges
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
18
(see appendix 3) separately for health welfare and education sectors although
there was much overlap in the challenges relating to each sector
Small groups involving two country based teams in each case took each social
challenge and considered how it may change and develop given current
understandings of the forces affecting change (some forces may promote change
and some may block change) These were considered against potential political
developments economic developments socialsociological change technological
development legallegislative changes and environmental factors with a focus on
volume nature depth timeframe and scale of importance in influencing future
developments in social services
This work informed extensive discussion at the INNOSERV June 2012 Consortium
meeting with regard to the impact of key future developments on innovation and
the choice of projects which should be used to test key innovation developments
and their relevance to future service development
Relevance is represented in the INNOSERV criteria framework by the lsquodriversrsquo box
which includes a number of examples The most significant social challenges and
changes which were identified by the Consortium as most pertinent to innovation in
social services are listed in table 2 (page 19) and are explored further in the
remainder of this section The selection of projects as case studies has included
analysis of which of these social challenges and changes are being addressed (see
Work Package 4 report Eurich and Strifler 2012)
41 Demographic change as a key societal change driving innovation in the
health and welfare social service sectors
Demographic change was identified as a driving force of innovation in both health
and welfare services in Europe Current demographic change is resulting in
increased numbers of people living longer into old age with a particular increase in
the numbers of people aged over 80 This is alongside a reduction in the numbers
of people of working age in part due to a declining birth rate Further socio-cultural
change is leading to concerns about levels of informal care for older people
While many people will want to live active lives in old age some will live with long
periods of ill health and will have complex care needs resulting from multiple co-
morbidities Most however prefer to live as independently as possible
Questions arise about the ability to meet these increasing care demands from
declining tax income bases In addition the specific needs of elderly patients with
dementia represent a unique challenge for nursing staff and the organisation of
nursing services Financing of the rising health care costs for public agencies or for
health insurance schemes requires sustainable solutions and structural reforms
Traditional models of hospital lsquoacutersquo care may not necessarily be appropriate for
meeting these health care needs
This all highlights the need to find alternative solutions to care needs including the
use of technology and reliance on informal carers Current responses which are
relevant to this driver include integration of health and social care services to
increase cost efficiencies use of technological solutions to enhance self care and
care at home and new paradigms such as Active Ageing
19
Table 2 Key social challenges and changes driving innovation
Social
challengesocial
change driving
innovation
Meaning Social service sector
in which driver is key
Demographic
change
Increase in numbers of over 65s Greatest
increase in over 80 age group Increase in
old age dependency ratio
Health sector
Welfare sector
Aspirations Rising expectations of citizens for better
quality of lifebetter care
Health sector
Education sector
Cross sector services of
education and health
Lifestyles Increase in certain diseases related to
obesity alcohol and drug consumption
and stress diabetes liver disease anxiety
and depression
Health sector
Cross sector services of
education and health
Technology Access to information new media
technology
Health sector
Continued
inequalities
Continued economic inequality
unemployment continued poverty
including child poverty continued
institutionalisation continued inequality for
people with disabilities ethnic minorities
gender inequalities impact of socio-
economic status on health outcomes
Welfare sector
Education sector
Cross sector services of
education and health
and welfare and
education
Independent living The approach now adopted by disabled
people to live as ordinary members of
society and in their chosen domestic
setting
Welfare sector
Social roles Changing families increase in single
households increase in single parent
families changing generational relations
(due to longer life expectancy) reduction in
extended families
Changing gender roles rising female
employment rates
Welfare sector
Education sector
Organisational
changes
Creating new organisational forms
application of more responsive
management processes performance
management culture
Welfare sector
Changing
management
styles
Application of more responsive
management processes
Education sector
Cross sector services of
education and health
20
42 Aspirations as a key societal change driving innovation for health and
for education service sectors
Citizen aspirations were identified as a key societal change acting as a driving force
for innovation within both the health and education sectors and across the
boundary of these sectors Across Europe citizens are expecting a better quality of
life including improved outcomes from health and care services and reduced
inequalities
In terms of the health service sector this both derives from and manifests itself in
a population which is more informed about health issues Consequently patients
wish to be more involved in decisions about their health and their health care
options and are more willing and able to participate in the management of their
condition There is less deference to the medical profession and greater willingness
to make demands on health services There are a growing number of patient led
movements which are challenging some medical traditions
This aspect is fundamental both to everyday practice and to the future development
trajectory for health care services While most health aspirations are limited by
current knowledge and medical skill as research and medical advance offer new
choices and opportunities but at greater costs there will be difficult questions for
political debate This could well result in very different more personalised and
lsquopatient managedrsquo models of health care support
In terms of the education service sector individualism and the connected
aspiration of lsquobeing involvedrsquo has been an increasing trend over the past years and
is expected to keep gaining importance This is not only reflected by agendas of
individually shaped curricula or learning arrangements in school but also by the
opening of the public (ie government funded) school system towards involvement
of the community (seniors in school corporate sponsoring external initiatives of
informal learning and personality formation etc) This is reflected in a similar way
in higher education (eg service learning) and adult education (lsquolearning regionsrsquo)
Across the boundary of health and education aspirations coupled with medical
advance lead to a desire for independence of disabled people and those with long
term conditions This highlights the need for health programs focussed on self
esteem
43 Lifestyles as a key societal challenge driving innovation in the health
service sector and also in the cross sector services of health and education
A key social challenge acting as a driving force for innovation for the health sector
and in the cross sector services of education and health is a recognised growth in
lsquolifestylersquo related conditions arising from unhealthy behaviours such as poor diet
alcohol consumption and smoking (although there is limited evidence of a decline
in smoking rates as its harmful effects are less well tolerated) Political investment
in public health is recognised as an important strategic ambition but often not
matched by financial resources Questions about personal responsibility are also
being asked with suggestions that people with poor health behaviours should not
be given the same priority to responsive health care services As other factors
impacting on health outcomes become more responsive to medical advance these
factors are growing in importance in their impact both on wider society and in
improving overall health outcomes
21
44 Technology as a key societal change driving innovation in the health
service sector
The growth in internet and web based technology is leading to an exponential
growth in access to information and new forms of communication More people
now use the internet as their primary health care information resource Web
lsquocommunitiesrsquo are linking and thus empowering people faced with similar health
challenges Telehealthcare solutions to on-going care needs are becoming more
widely available and are changing the patterns of demands for some health care
services Other new technologies for example in transport and in home assistance
devices are enabling greater independence for disabled people
As future generations use and expect more from access to information and
communication services health care services will have to respond to both the
demands and the opportunities created by such technology Technology can be
seen as both a driving force for innovation and as an enabler of change
45 Continued inequalities as a key societal challenge driving innovation in
welfare and education service sectors also in cross sector services of
education and health and welfare and education
Continued inequalities were identified as a key driving force for innovation within
both welfare and education sectors and in services which straddle the boundary
between education and health services and education and welfare services
Inequalities stem from issues of migration social originbackground
unemployment disability and gender and have been a source of the social
upheaval which has been seen in Europe in recent months
Within health education the link between socio-economic status and health is clear
with people from lower socio-economic groups experiencing poorer health and less
likely engaging in health promoting behaviours In the case of migrants health
messages need to be delivered in a culturally appropriate manner
46 Independent living as a key societal change driving innovation in the
welfare service sector
In terms of disability the emergence and spread of the independent living
philosophy has been a key change driving innovation in the welfare service sector
Typically innovation in this field involves new stakeholder roles with a much more
proactive role for service users in all stages of service provision design
implementation monitoring and fine tuning of services as well as a role in
coordination of different entitlementsservices andor administration and reporting
requirements The boundaries are being pushed further deeper and wider every
day Starting from persons with physical disabilities services are now promoting
active involvement of persons with severe mental disabilities a development that
was deemed impossible only 30 years ago
47 Social roles as a key societal change driving innovation for welfare and
for education service sectors
Changing social roles were identified as a key challenge driving innovation within
the welfare and education sectors These changes are within families and of the
family itself and include changing gender roles and changing family structures (eg
increase in single parent families increase in the numbers of older people living
alone) Families seem to be becoming a sphere of public or community interest
rather than an exclusively private one
Proper lsquosocializationrsquo of children is the key to building viable and sustainable
futures for individuals Early stage family intervention is necessary to prevent the
22
very emergence of conflicts lsquoExternalrsquo interventions often do not reach every day
interaction and thus the root causes of problems This is of significance for family
based projects as well as for care institutions and education providers
48 Organisational changes as a key societal change driving innovation in
welfare service sectors
The shifting of provision of services from the public sector into other sectors such
as independent profit making companies and social enterprises creates new
opportunities for innovation In addition there is an increasing move to provide
services locally in order to be more relevant and responsive and a move to
community based models of care
49 Changing management styles as a key innovation challenge for the
education service sector and in cross sector services of the health and
education sector
Connected to individualism as well as new social roles of individuals family
community and institutions management styles shaped by multi-stakeholder
involvement are gaining importance Community based models do not only increase
the complexity of players involved in the lsquovalue creationrsquo process but also the
enhancement of skill development and personality formation as well as the
fertilization of the educational landscape by innovative ideas expertise and
practices of diverse partners The latter fact also stimulates an increase in cross-
sectoral services (education health and social services) Simultaneously this
situation increases the necessity to spot choose and foster the lsquoinfluencesrsquo and
lsquocombinationsrsquo which realize the highest value through the assessment of social
impact
Increased emphasis is also being placed on illustrating and monitoring
performance Impact measurement and associated tools and practices gain
overarching importance
In terms of changing management styles within the health and education sector an
important aspect is the cooperation of different stakeholders and the involvement
of the community or userrsquos perspective Linked to increased user aspirations
people would like to take part in the development of programs and services With
their special knowledge of their condition for example they can contribute their
expertise within social services
23
5 Other key challenges driving innovation
Sociatal challenges and changes are of course only one driving force of innovation
In addition to these there are other meso and micro level factors which also drive
innovation These include research and development leading to new knowledge
professionally led innovation in response to users needs increasing costs of service
provision and demands for greater efficiency per se and specific political contexts
These other forces are included in the INNOSERV criteria framework in the
lsquochallengesrsquo box These factors are not a key focus for selection of projects for
INNOSERV as they are often very situation specific but will be noted in the case
studies where relevant The factors which prompt or trigger specific innovations
whether socially based or otherwise are not are not mutually exclusive (Bason
2010) and in there is a complex and interacting relationship between a variety of
factors for any given innovation lsquoinstancersquo In addition there are well documented
factors which act to inhibit the development of innovative responses (see Crepaldi
et al 201215)
This work package has sought to identify generic criteria and drivers but it must be
recognised that the dynamics of individual settings and local factors will impact on
the actual processes of adoption
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
24
6 Conclusions and next steps
This report has presented the framework which has been used within the INNOSERV
project to support the choice of innovative case studies and to assist in identifying
the innovation phenomena potential and processes important to future research in
this area The framework has been used to select projects as case studies (see Work
Package 4 report Eurich and Strifler 2012) The framework interlinks aspects of
innovation (novelty type context improvement sustainability) with analysis of
challenges and changes which are acting as driving forces of innovation in social
services As the project is future facing it is proposed that key social challenges
and changes are likely to inform the development of new change paradigms for the
delivery of social services across Europe The framework will inform further
development and testing of concepts through the next stages of the INNOSERVE
programme This process will result in descriptions for the key areas in which future
research on innovation in social services should be taken forward
25
7 Bibliography
Bason C (2010) Leading public sector innovation Co-creating for a better society
Bristol The Policy Press
Bereiter C (2002) Design research for sustained innovation Cognitive Studies
Bulletin of the Japanese Cognitive Society 9 321-327
Christensen CM and Overdorf M (2000) Meeting the Challenge of Disruptive
Change Harvard Business Review March-April
Clark M and Goodwin N (2010) Sustaining innovation in telehealth and telecare
WSDNA briefing paper London The Kings Fund
Crepaldi C De Rosa E And Pesce F (2012) Literature review on innovation in
social services in Europe (sectors of Health Education and Welfare
Services)INNOSERV Work Package 1 report
Department of Health (2011) Innovation Health and Wealth Accelerating Adoption
and Diffusion in the NHS London Department of Health
Eurich J and Strifler A (2012) European compared selection of innovative social
services INNOSERV Work Package 4 report
Fuglsang L (2010) Bricolage and invisible innovation in public service innovation
Journal of Innovation Economics 5 67-87
Greenhalgh T Robert G Macfarlane F Bate P Kyriakidou O (2004) Diffusion of
innovations in service organizations systematic review and recommendations
Milbank Quarterly 82581-629
Hartley J (2005) Innovation in Governance and Public Services Past and Present
Public Money and Management 25127-34
Koch P and Hauknes J (2005) On innovation in the Public Sector Publin report no
D20
Kuhn T (1962) The Structure of Scientific Revolutions Chicago The University of
Chicago Press
Lakatos I and Musgrave A (eds) (1970) Criticism and the growth of knowledge
London Cambridge University Press
May
C Finch T Mair F et al ( 2007) Understanding the implementation of
complex interventions in health care the normalization process model BMC Health
Services Research 2007 7148 doi1011861472-6963-7-148
May et al (2009) Implementing Embedding and Integrating Practices An Outline of
Normalization Process Theory Sociology 43 535-554
Murray R Caulier-Grice J and Mulgan G (2010) The Open Book of Social
Innovation London The Young Foundation
26
OECD (2005) Oslo manual Guidelines for collecting and interpreting innovation
data 3rd
edition
Oliver M (1990) The politics of disablement Basingstoke Macmillan Education Ltd
Osborne S (1998) Naming the Beast Defining and Classifying Service Innovations
in Social Policy Human Relations 51 9 1133-1154
Osborne S and Brown K (2005) Managing Change and Innovation in Public Service
Organizations London Routledge
Phills JA Deiglmeier K and Miller DT (2008) Rediscovering Social Innovation
Stamford Innovation Review 6 4 34-43
Sullivan M (1987) Sociology and Social Welfare London Allen and Unwin
Tidd J and Bessant J (2009) Managing Innovation Integrating Technological
Market and organizational Change 4th
edition Chichester John Wiley and Sons
UK Government Department of Health (2011) Innovation Health and Wealth
Accelerating adoption and diffusion in the NHS London Department of Health
Wolfensburger W (1975) The principle of normalisation in human services Toronto
National Institute on Mental Retardation
27
8 Appendices
Appendix 1 Summary of types and criteria of innovation used in Work Package
3 to identify practices
Identification of social service
Field(s) of service
Logic(s) of service
Self help or mutual aid logic Social care logic Multi-stakeholders logic Social
movements logic Combination
Activities of services delivered
Assistance for persons faced with personal challenges or crises (debt unemployment
drug addiction other) (Re)integration of persons into society (rehabilitation language
training for immigrants other) Services to the labour market (occupational training)
Social housing for disadvantaged groups Care (for the elderly children families )
Treatment and support of people with physical illnesses Treatment and support of
people with mental health problems Combination
Status of the provider organization
Public organization (governmental) Private organization ndash nonnot for profit Private
organization ndash profit Volunteer association Cooperative company or mutual company
Familyneighbourhood Civil society network Combination Other
Target group
Children Youngsters Elder people Unemployed people Poor people Immigrants
Disabled people People with chronic diseases ndash long-term health problems People with
acute or short term health problems No specific target group (eg territory-based social
services provision aiming at strengthen social ties) Combination Other
Size of the organization
Innovation
Type of innovation
New forms of organization resources hybridization new targeted actions new services
non-structural practices other
Innovative character
do the service practices appear to be something new in the field of social services
Origins of innovation
Supply side demand side broader operating factors
Impact on service performance
Effectiveness of service delivery
from user perspective cost effectivenesscapacity building sustainability of
innovation
Quality of provision
28
Socialization quality of life as judged by users and beneficiaries more inclusion
lower risk on exclusion participation of the user transition from institutional to
community based care
Potential wider effects
Promoting social and health equality sustainability new skills and jobs
increased social rights affordability of adequate and high quality health and long-
term care promotion of equality and non-discrimination equal access to adequate
provision
Transferability of innovations between national contexts
29
Appendix 2 levels of innovation identified within INNOSERV Work Package 2
literature review
Organizational level (policy organizational sectors)
New social services designed to face new needs or unmet needs
Search for new solutions to old needs new mechanisms or practices introduced in
preexisting
social services
to improve access to social services (ie more information increased
professionalism in
social work sector)
to guarantee entitlements (rights) for specific groups or minorities
to satisfy the demand for social services in a more complete and broad way
(holistic
approach)
to guarantee more participation and inclusion of citizens
New and increased Cross-Sectoral social services
Cross-Sectoral social services (ie teaching art to children while helping their mothers
for
job seeking and offering jobs for young artists)
Integrated care practices
Tearing down walls between sectors and the role of informal care
Sharing of knowledge
Better integration of Health and Social sector services
Territory based social services that contribute to the creation of training and job
opportunities for disadvantaged people
Solidarity-based social services
Social mediation for impaired and weakened people
Easy access to housing for poor families
New interfaces with clients
Logic(s) of service Self help or mutual aid logic Social care logic Multi-stakeholders
logic
Social movements logic
The development of the self-help sector
Actors New organizations (Cooperative society for social service provision ndashSCOP
Cooperative society as social enterprise with userrsquos involvement ndashSCIC)
New legal forms within structured public frameworks (Italy social cooperatives)
New provider organizations and existing organisations refashioned by new dynamics
New roles and relations among actors
New private organizations for profit and non-profit
Management style in the organization
Regulatory and legislative level
New architecture of the provision system
Socially responsible public contracts and social clauses (outsourcing)
Adherence to EU standards in transitional economies
Impact on institutional framework that shape innovation in social services
New arrangement between one or more government agencies andor external
organization
Organizational level ndash Connection and Cooperation (governance and partnership)
New networks and social movements established in order to design deliver and
finance
social services
Cooperation between sectors actors and different forms of provision
Cooperation between local actors
Increasing communication responsiveness
30
Utilizing connectivity and interdependencies
Modification of organizational systems (models of governance work organisation
number
of involved stakeholders in governance)
Public sector and local authorities as promoters of innovation and promoters of
crosssectoral
policy strategies
Third sector and user as promoters of innovation
Volunteer workers and initiatives launched by a group of citizens
Third sector and userrsquos engagement design (co-design and re-design services)
Joint decision process
Decision-making power not based on capital ownership
Employee and user driven innovation
Partnerships with users family carers and user organizations
Partnership between service users practitioners and academics
Community-based and participative health network in a local territory
Collaboration between public and volunteer organisations (NGOs) or between civil and
local
networks in collaboration with public organisations and social enterprises
New techniques for partnership building and functioning
Impact on social and power relations
Professional level (practitioners)
New practices in social work
Innovative tools (ie Theatre of the Oppressed) and the use of participated methods in
social
work (ie self-help group)
Networking
Individualised supports
New professional skills in social work
The use of informatics and new technologies in social work
Users
Participation and involvement of final users of services in designing delivering and
evaluating social services
Involvement of final users in promoting equality effectiveness and control and
adherence
to the needs of users
Conceptual Level (and value)
New models of society - Social goals participation user involvement community
benefit
New paradigms underlying a new social service concept or service delivery model (ie
new
inclusion paradigm active ageing)
Relationships and trust
Pursuing diversity
Better adjustment to usersrsquo needs more person centred support
More social services provision in less developed regions
New concept of accessibility of the service (ie for Roma families)
The concept of lsquoprogressive universalismrsquo
The Social Care Model
De-institutionalization and community care Improved home-based and community
services
Gender and diversity perspectives
Anti-discrimination and equality process
Increase of the level of recognition of social values objectives paradigms and goals
New models of interaction leading to social innovation processes
31
Public policy level (policy framework programs and social policies)
The new role of the system governance played by central (or local depending on
national
arrangements) government
Impact on public policies new public policy programme measure or intervention
Joint construction of a space for public action and redefinition of public governance
bodies
and methods
Innovative logics for public policies
Innovating the public sector
The new wide attention on anti stigma policies
E-government
Financial and economic sustainability level (and scaling-diffusion-transferability
of innovation)
New ways to overcome budgetary constraints
New approaches to acquire funding
The involvement of private investors
The introduction of special funds
The purchase of innovative practices by final users
Hybridization of resources (market redistribution and reciprocity resources)
New investment sources
Mobilising community resources taking full advantage of all endogenous resources
Improvement in efficiency and effectiveness
Financial and systemic sustainability Impact on the economy
Economic Environmental and Social Sustainability of Territory based social services
Financial tools necessary to territorial social initiatives and the way to unlock them
Capacity of spreading and diffusion
Evaluative level and attention for quality
Affordability availability and accessibility
New standards expected
New feedback loops from users and specialists
Social services of excellence as for quality efficiency and efficacy
New methods and creative tool-kits to strengthen and renew the quality of social care
services
Low-cost (for user) and high level quality of social services
Quality assurance moderation and accreditation mechanisms
New tools for monitoring social services - hearing all voices (users organizations
practioners staff family and friends)
Action research
Alternative economic and social indicators
Social impact and contribution of innovation in social services to social innovation and
social change ndash Assessment of innovation
Learning approach to evaluation ndash lsquoto learn from failuresrsquo
Developmental evaluation
Specifics for the Health sector
Disability from rehabilitation to integration and then to inclusion
Mental Health from segregation to inclusion and community care
HIV from segregationstigmatization to awareness campaigns for promoting self
protection
Innovation in the area of prevention of treatment and in the introduction of new
technologies
Emphasis on an inter-sectoral controlled and steered care in managed care models
replacement of the traditional insurance model
Integrated services
Technological progress
32
Specifics for the Education sector
Inclusive education
Inclusive education and training in collaboration with the civil society
Multicultural education
Integration of disciplines
Alternative schools non-regular schools and informal education
Link between formal and informal education
Community development based approaches
Connection between regular school and the system of social services
Experiential learning
Human rights education
Working lsquothrough relationshipsrsquo with children and young people
Problem based learning methodology
The lsquomedia educationrsquo The use of comics
ICT in schools
E-inclusion
Networks of schools
Improve supplement reinvent and transform learning
Sustained educational improvement
Learning Beyond the Classroom
Spreading a culture that values learning
More personalized approaches to learning
Using the web
Learning with and by not to and from
33
Appendix 3 analysis of social challenges and changes driving innovation
Welfare
Societal
change as
driving force
of innovation
in social
services
Meaning
description
Related
outcomesother
factors
Examples of innovative
responses
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
Empowerment self-
determination choice
The lsquoassertive userrsquo
Demand for more
individualised services of
better quality
Alternativecomplementary
providers
Personalisation
Co-production (new
userprofessional
relationships)
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demand on services
Potential for poor access
to services (from
communication
problems social
isolation)
Multiculturalism
Integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Declining female
caregiving
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
34
Increased demand for
services demand for
formal care
Continued
inequality
Continued
economic
inequality
unemployment
continued poverty
including child
poverty continued
institutionalisation
continued
inequality for
people with
disabilities ethnic
minorities gender
inequalities
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients
with complex
comorbidities increase
in certain diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing demand for
services Increasing
costsneed to make
limited resources go
further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
Decisions about value
marketization
Technological
development
Access to
information new
media technology
Facilitates self
determination increases
expectations and choice
population better
informed about
conditionsservicesright
s and less deferential
Users better able to
35
mobilise
Increased exclusion of
some groups with limited
access
New models of remote
care provision
Ability to exchange
information on quality
and experience
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Increasing costs
Decisions about value
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Organisational
change changing
management
styles
philosophies
Creating new
organisational
forms application
of more responsive
management
processes
performance
management
culture
Integration of
organisationsfunctions
new approaches to
lsquocommissioningrsquo of
organisationsservices
distortions caused by
lsquolocked inrsquo expenditures
(tertiary health care
residential care)
Decentralisation
deinstitutionalisation
marketization liberalisation
The lsquoenabling
statersquo Political
will fiscal space
Impact of financial
crisis competing
priorities for public
funds
Legacy of category-based
(not needs based) social
protection structural
transition
deindustrialisation
Health
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
EmpowermentSelf-
determination choice
Demand for more
individualised services of
better quality
Users better able to mobilise
Assertive lsquouserrsquo
knowledgeable patient
Alternativecomplimentary
providers
36
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demands on
services
Potential for poor access
to services (from
communication
problems social
isolation)
MulticulturalismTrained
health professionals
move to richer countries
integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Declining female
caregiving
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
Increased demand for
formal care services
Continued
inequalities
Unequal
distribution of
health risks and
health
outcomediseases
by socioeconomic
indicators
Unequal access to
care by social
status geography
gender and
ethnicity
Demographic Increase in
numbers of over
Increase in patients with
complex comorbidities
Increasing demand for care
Decisions about value Active
37
change 65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing costsneed to
make limited resources
go further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
ageing paradigm
Technological
development
Access to
information new
media technology
Self determination
expectations choice
population better
informed about
conditionsservicesright
s and less deferential
Ability to exchange
information on quality
and experience
New models of care provision
(eg telehealth care) new
health management systems
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Changing
management
stylesphilosophi
es
Application of
more responsive
management
processes
Decentralisation
deinstitutionalisation
marketization liberalisation
Lifestyle changes Increase in certain
diseases related to
obesity alcohol
and drug
Increasing
costsdemands for care
38
consumption and
stress diabetes
liver disease
anxiety and
depression
Education
Aspirations Rising expectations
by citizens for
better quality of
life
Self determination
choice consumerism
Education outside of formal
setting
Assertive user
Lifelong learningeducation
Migration Historical (post
colonial) migration
pan-EU migration
refugees
New needs for education
eg language and culture
Inequalities social
fragmentation
Social Roles Changing family
structure increase
in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
changing gender
roles rising
female
employment rates
Need to reconcile work
and family life
Parentingfamily skills
for vulnerable
parentsfamilies
Socialization of children
ndash social and emotional
deficits for children in
some environments
Work with families and
communities
Continued
inequalities
Inequality in
educational
accessattainment
by socioeconomic
status gender
people with
disabilities ethnic
minorities
Culture of failure
Promise to deliver social
mobility and economic
improvement
(Leadbeater and Wond
2010 pp 5-20)
Inclusive and multicultural
education
Differential support for
children from
lsquodisadvantagedrsquo
backgrounds
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients with
complex comorbidities
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
New group of older
39
learners
Technological
advance
Access to
information new
media technology
making learning
available in new
ways
Self determination
expectations choice
lsquoAssertive userrsquo
Increased exclusion of
some groups with limited
access
Changing
management
styles
philosophies
Community based models
Globalization Need to provide
educationtraining
which is suited to
modern knowledge
based global
economies
This report for the InnoServ project (grant agreement nr 290542) is supported
under the Socio-economic and Humanities Programme of FP7
Chris Hawker
Faculty of Health Sciences University of Southampton Building 67 University Road Highfield Campus Southampton SO17 1BJ
Tel +44 (0)23 8059 7968
Email CHawkersotonacuk
11
From this five types of response are detailed within the INNOSERV criteria
framework new service new form of delivery new form of governance new form of
resourcing and new way of evaluation The meaning of these five levels is provided
in table 1 and examples are given to illustrate this It should be noted that the
levels of response are not necessarily exclusive and a specific practice innovation
may fall into more than one category
Box 3 identified levels of innovation in social services
organizational level (ie organization of the provision of social services
type of service target group delivering logics)
regulatory and legislative level (lsquohow services are regulated organised
provided and financed the modalities of service provision the types of
relationships between external service providers and public authoritiesrsquo
EC 2006 p 8)
organizational level ndash connection and cooperation (partnership
networks governance)
professional level (social work methods and practices) -
users level
conceptual level and values
public policy level (policy framework programs and social policies)
financial and economic sustainability level (and scaling-diffusion-
transferability of innovation)
evaluative level and attention to quality (quality standards)
Crepaldi et al 2012 98-99
12
Table 1 Levels of response
Response Definition Example
New service New or improved
product of the scheme
or process
Personalised instead of
generic service
New form of delivery New or improved means
by which the outcome is
achieved
Self-help or social enterprise
instead of government agency
New form of
governance
New or improved way
the scheme or process is
managed and where it
draws authority from
Co-operative or user managed
instead of public service
New form of
resourcing
New or improved
financial human or
physical inputs to the
scheme or process
Grant-funded collectively
staffed organisation instead of
professionally managed
government agency
New way of
evaluation
New or improved
parameters by which
success is judged
User assessment of
effectiveness instead or
professional determined
criteria
It is important to note that innovation within a service is more challenging to define
and measure than innovation in the sense of a product (OECD 2005) while a
product is a tangible entity innovation within service provision can be a either a
product or a process and can occur at different levels of service provision and there
are a number of potential complexities which may inform the structure set out in
table 1
Phills et al (2008) for instance state that social innovation can be
ldquoa product production process or technology (much like innovation in
general) but it can also be a principle an idea a piece of legislation a social
movement an intervention or some combination of themrdquo (39)
In discussing public sector services Hartley (2005) emphasises that innovation is
ldquonot just a new idea but a new practicerdquo (27) and argues therefore that definitions
need to recognise practical impact For services this impact might be at one of
several levels
The organisation literature on innovation offers the initial distinction between
product and process innovation to which other types of innovation have been
added such as position and paradigm innovation (Tidd and Bessant 2009) For
social service oriented innovation further types are added
For example Hartley (2005) identifies the levels of product service process
position strategic governance and rhetorical innovations Hochgerner (2011) adds
social types of innovation to include roles relations norms and values
13
Osborne and Brown (2005) critique a number of typologies to classify innovation
from the management literature They point out that the dichotomy between
process and outcome makes them alternatives whereas an innovation and
particularly innovation in services can be both With services there is often not a
distinct separation between product and process with production delivery and
consumption of services often occurring simultaneously (OECD 2005)
32 Novelty
The next aspect is innovation is novelty In terms of novelty a three way
categorisation is proposed for INNOSERV new perspectives on old needs or
problems new practices for old needs or problems a new practice for a new need
The categorisation reflects the need for innovation to address both existing needs
and new needs Again there is much discussion in the literature about novelty in
relation to innovation Two points are addressed which can be summarised as
lsquowhat degreelevel of novelty equates to innovationrsquo and lsquonew to whomrsquo
The first distinction to be made is between different levels of innovation
ldquoThere are degrees of noveltyrunning from minor incremental
improvements right through to radical changes which transform the way we
think about and use them Sometimes these changes are common to a
particular sector or activity but sometimes they are so radical and far-
reaching that they change the basis of societyhelliprdquo (Tidd and Bessant 2009
27)
Tidd and Bessant usefully break down the incremental-radical continuum as lsquodoing
what we do betterrsquo lsquonew to the enterprisersquo and lsquonew to the worldrsquo (Tidd and
Bessant 2009 38)
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
14
While for some writers a change must be radical or pattern breaking in order to be
innovation it has been argued that within services innovation can be small
adjustments (Fuglsang 2010) Fuglsang in fact argues for a view of innovation in
public sector services as a process of building of skills and expanding routines (68)
The second part of the argument lsquonew to whomrsquo is whether innovation relates to
absolute first use A common to view of innovation is not just those elements
developed within an institution but also those adopted from others (for example
see OECD (2005) for business sector innovation Phills et al (2008) regarding social
innovation Hartley (2005) and Koch (2005) in relation to innovation in public
services) Phills et al (2008) for example state
ldquoAlthough innovations need not necessarily be original they must be new to
the user context or applicationrdquo (Phills et al 37)
Osborne and Brown (2005) purport that most studies consider newness as new to a
person organisation society or situation but not necessarily first use (2005 120)
The authors go on to argue that these are in fact different forms of innovation
differently termed as objective and subjective innovation (Kimberly 1981) or
intrinsic and extrinsic innovation (Downs and Mohr 1976)
Hartley (2005) expounds the dissemination and adaptation of innovation to other
contexts as particularly important for public sector services arguing that public
goals ldquocan be enhanced through collaborative arrangements to create share
transfer adapt and embed good practicerdquo (27) She terms this ldquorsquolateralrsquo innovationrdquo
(33) of good practice adoption and adaption
An example of this approach to defining innovation within social services is seen in
the UK Government policy document on innovation within the National Health
Service which states
ldquoinnovation is as much about applying an idea service or product in a new
context or in a new organisation as it is about creating something newrdquo
(Department of Health 2011 9)
15
33 Hallmarks of innovation
Within social service systems it is not sufficient to focus only on novelty as a
marker of innovation In addition the INNOSERV framework includes certain
hallmarks of innovation including assessment of context quality and sustainability
331 Contextual fit
Different innovative approaches need to fit within different service framework
contexts and need adaptation to those contexts Drawing further on the above
discussion of novelty INNOSERV employ this to mean new to a given (for example
national) context This will reflect the diversity of social service contexts within the
European Union Case studies will also consider transferability of an innovation
from one context to another
332 Improvement in quality
ldquoIn public servicesinnovation is justifiable only where it increases public
value in the quality efficiency or fitness for purpose of governance or
servicesrdquo (Hartley 2005 30)
It is commonly understood that innovation is about improvement as well as novelty
Hartley (2005) offers a model which sets out the possible relationships between
innovation and improvement These relationships are for organisations showing no
improvement and no innovation improvement but no innovation innovation but no
improvement innovation and improvement Important points to highlight from this
model relate to innovation but no improvement first that innovations may not
always lead to success and a level of failure is to be expected second that
innovation can lead to increased but undesired choice loss of performance due to
the process of learning and innovations that are ultimately of no value In terms of
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
16
what is to be measured as improvement Hartley maintains that beyond
improvements in service quality and fitness for purpose wider issues of public
value should be considered
The difficulties of measurement and evaluation of innovation in social services need
to be highlighted as the measures of success within a social project are difficult to
define (Bason 2010 Murray et al 2010) Improvement of social services can
include improved quality of life and access to economic and social opportunity
These issues may relate differently in the fields of health welfare and education
For instance quality of life within health may relate to physical health and mental
wellbeing at different stages of life within welfare issues such as equality of access
to housing cultural and community activities and employment are important
The INNOSERV case studies will include available information on the outcomes of
the innovative project although these will likely vary in terms of types of
measurement used by the projects
333 Sustainability
ldquoInnovation is not just about the originating idea but also the whole process
of the successful development implementation and spread of that idea into
widespread userdquo (Department of Health 2011)
It is recognised that change through innovation needs to be sustainable (Bereiter
2002) Achieving a sustainable innovation may involve streamlining of ideas and
altering them to work in everyday practice (Murray et al 2010 12) The
Normalisation Process Model offered by May and colleagues (May et al 2007 May
et al 2009) provides a theoretical explanation within the context of health care of
the processes through which interventions become embedded in practice and then
integrated and sustained
17
4 Drivers of innovation key societal changes
Innovation within social services needs to be relevant to key social challenges and
changes This relates to the purpose of social services in responding to pressing
social demands and societal needs It is therefore important for the INNOSERV
project to have an understanding of the key social challenges and changes driving
innovation to inform the lsquotheoretical trendsrsquo influencing future innovation
requirements As part of this work package we have therefore sought to identify
social challenges and changes which may act as driving forces of innovation and
shape the development of social service lsquoparadigmsrsquo and hence future social
change
Using a lsquoscenario planningrsquo methodology borrowed from management science can
help to test the limits to any paradigm and identify where new paradigm models
may be needed in the future This in turn should help to identify where future
research interests could be located to explore not just opportunities for innovation
within the current paradigm but also where socially driven change is creating new
opportunities (or indeed requirements) for social and social services innovation
Further these challenges feed into social service provision in terms of an imperative
to address new needs and level of need and issues of rising costs
The INNOSERV project undertook such a scenario planning process the outcomes
of which inform what follows here Using an extended literature study on future
social challenges in the European context a number of key factors promoting a
response from and requiring change in social services were identified Individual
partners made further analysis of the important social challenges within their own
national context The factors were synthesised into a table of key social challenges
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
18
(see appendix 3) separately for health welfare and education sectors although
there was much overlap in the challenges relating to each sector
Small groups involving two country based teams in each case took each social
challenge and considered how it may change and develop given current
understandings of the forces affecting change (some forces may promote change
and some may block change) These were considered against potential political
developments economic developments socialsociological change technological
development legallegislative changes and environmental factors with a focus on
volume nature depth timeframe and scale of importance in influencing future
developments in social services
This work informed extensive discussion at the INNOSERV June 2012 Consortium
meeting with regard to the impact of key future developments on innovation and
the choice of projects which should be used to test key innovation developments
and their relevance to future service development
Relevance is represented in the INNOSERV criteria framework by the lsquodriversrsquo box
which includes a number of examples The most significant social challenges and
changes which were identified by the Consortium as most pertinent to innovation in
social services are listed in table 2 (page 19) and are explored further in the
remainder of this section The selection of projects as case studies has included
analysis of which of these social challenges and changes are being addressed (see
Work Package 4 report Eurich and Strifler 2012)
41 Demographic change as a key societal change driving innovation in the
health and welfare social service sectors
Demographic change was identified as a driving force of innovation in both health
and welfare services in Europe Current demographic change is resulting in
increased numbers of people living longer into old age with a particular increase in
the numbers of people aged over 80 This is alongside a reduction in the numbers
of people of working age in part due to a declining birth rate Further socio-cultural
change is leading to concerns about levels of informal care for older people
While many people will want to live active lives in old age some will live with long
periods of ill health and will have complex care needs resulting from multiple co-
morbidities Most however prefer to live as independently as possible
Questions arise about the ability to meet these increasing care demands from
declining tax income bases In addition the specific needs of elderly patients with
dementia represent a unique challenge for nursing staff and the organisation of
nursing services Financing of the rising health care costs for public agencies or for
health insurance schemes requires sustainable solutions and structural reforms
Traditional models of hospital lsquoacutersquo care may not necessarily be appropriate for
meeting these health care needs
This all highlights the need to find alternative solutions to care needs including the
use of technology and reliance on informal carers Current responses which are
relevant to this driver include integration of health and social care services to
increase cost efficiencies use of technological solutions to enhance self care and
care at home and new paradigms such as Active Ageing
19
Table 2 Key social challenges and changes driving innovation
Social
challengesocial
change driving
innovation
Meaning Social service sector
in which driver is key
Demographic
change
Increase in numbers of over 65s Greatest
increase in over 80 age group Increase in
old age dependency ratio
Health sector
Welfare sector
Aspirations Rising expectations of citizens for better
quality of lifebetter care
Health sector
Education sector
Cross sector services of
education and health
Lifestyles Increase in certain diseases related to
obesity alcohol and drug consumption
and stress diabetes liver disease anxiety
and depression
Health sector
Cross sector services of
education and health
Technology Access to information new media
technology
Health sector
Continued
inequalities
Continued economic inequality
unemployment continued poverty
including child poverty continued
institutionalisation continued inequality for
people with disabilities ethnic minorities
gender inequalities impact of socio-
economic status on health outcomes
Welfare sector
Education sector
Cross sector services of
education and health
and welfare and
education
Independent living The approach now adopted by disabled
people to live as ordinary members of
society and in their chosen domestic
setting
Welfare sector
Social roles Changing families increase in single
households increase in single parent
families changing generational relations
(due to longer life expectancy) reduction in
extended families
Changing gender roles rising female
employment rates
Welfare sector
Education sector
Organisational
changes
Creating new organisational forms
application of more responsive
management processes performance
management culture
Welfare sector
Changing
management
styles
Application of more responsive
management processes
Education sector
Cross sector services of
education and health
20
42 Aspirations as a key societal change driving innovation for health and
for education service sectors
Citizen aspirations were identified as a key societal change acting as a driving force
for innovation within both the health and education sectors and across the
boundary of these sectors Across Europe citizens are expecting a better quality of
life including improved outcomes from health and care services and reduced
inequalities
In terms of the health service sector this both derives from and manifests itself in
a population which is more informed about health issues Consequently patients
wish to be more involved in decisions about their health and their health care
options and are more willing and able to participate in the management of their
condition There is less deference to the medical profession and greater willingness
to make demands on health services There are a growing number of patient led
movements which are challenging some medical traditions
This aspect is fundamental both to everyday practice and to the future development
trajectory for health care services While most health aspirations are limited by
current knowledge and medical skill as research and medical advance offer new
choices and opportunities but at greater costs there will be difficult questions for
political debate This could well result in very different more personalised and
lsquopatient managedrsquo models of health care support
In terms of the education service sector individualism and the connected
aspiration of lsquobeing involvedrsquo has been an increasing trend over the past years and
is expected to keep gaining importance This is not only reflected by agendas of
individually shaped curricula or learning arrangements in school but also by the
opening of the public (ie government funded) school system towards involvement
of the community (seniors in school corporate sponsoring external initiatives of
informal learning and personality formation etc) This is reflected in a similar way
in higher education (eg service learning) and adult education (lsquolearning regionsrsquo)
Across the boundary of health and education aspirations coupled with medical
advance lead to a desire for independence of disabled people and those with long
term conditions This highlights the need for health programs focussed on self
esteem
43 Lifestyles as a key societal challenge driving innovation in the health
service sector and also in the cross sector services of health and education
A key social challenge acting as a driving force for innovation for the health sector
and in the cross sector services of education and health is a recognised growth in
lsquolifestylersquo related conditions arising from unhealthy behaviours such as poor diet
alcohol consumption and smoking (although there is limited evidence of a decline
in smoking rates as its harmful effects are less well tolerated) Political investment
in public health is recognised as an important strategic ambition but often not
matched by financial resources Questions about personal responsibility are also
being asked with suggestions that people with poor health behaviours should not
be given the same priority to responsive health care services As other factors
impacting on health outcomes become more responsive to medical advance these
factors are growing in importance in their impact both on wider society and in
improving overall health outcomes
21
44 Technology as a key societal change driving innovation in the health
service sector
The growth in internet and web based technology is leading to an exponential
growth in access to information and new forms of communication More people
now use the internet as their primary health care information resource Web
lsquocommunitiesrsquo are linking and thus empowering people faced with similar health
challenges Telehealthcare solutions to on-going care needs are becoming more
widely available and are changing the patterns of demands for some health care
services Other new technologies for example in transport and in home assistance
devices are enabling greater independence for disabled people
As future generations use and expect more from access to information and
communication services health care services will have to respond to both the
demands and the opportunities created by such technology Technology can be
seen as both a driving force for innovation and as an enabler of change
45 Continued inequalities as a key societal challenge driving innovation in
welfare and education service sectors also in cross sector services of
education and health and welfare and education
Continued inequalities were identified as a key driving force for innovation within
both welfare and education sectors and in services which straddle the boundary
between education and health services and education and welfare services
Inequalities stem from issues of migration social originbackground
unemployment disability and gender and have been a source of the social
upheaval which has been seen in Europe in recent months
Within health education the link between socio-economic status and health is clear
with people from lower socio-economic groups experiencing poorer health and less
likely engaging in health promoting behaviours In the case of migrants health
messages need to be delivered in a culturally appropriate manner
46 Independent living as a key societal change driving innovation in the
welfare service sector
In terms of disability the emergence and spread of the independent living
philosophy has been a key change driving innovation in the welfare service sector
Typically innovation in this field involves new stakeholder roles with a much more
proactive role for service users in all stages of service provision design
implementation monitoring and fine tuning of services as well as a role in
coordination of different entitlementsservices andor administration and reporting
requirements The boundaries are being pushed further deeper and wider every
day Starting from persons with physical disabilities services are now promoting
active involvement of persons with severe mental disabilities a development that
was deemed impossible only 30 years ago
47 Social roles as a key societal change driving innovation for welfare and
for education service sectors
Changing social roles were identified as a key challenge driving innovation within
the welfare and education sectors These changes are within families and of the
family itself and include changing gender roles and changing family structures (eg
increase in single parent families increase in the numbers of older people living
alone) Families seem to be becoming a sphere of public or community interest
rather than an exclusively private one
Proper lsquosocializationrsquo of children is the key to building viable and sustainable
futures for individuals Early stage family intervention is necessary to prevent the
22
very emergence of conflicts lsquoExternalrsquo interventions often do not reach every day
interaction and thus the root causes of problems This is of significance for family
based projects as well as for care institutions and education providers
48 Organisational changes as a key societal change driving innovation in
welfare service sectors
The shifting of provision of services from the public sector into other sectors such
as independent profit making companies and social enterprises creates new
opportunities for innovation In addition there is an increasing move to provide
services locally in order to be more relevant and responsive and a move to
community based models of care
49 Changing management styles as a key innovation challenge for the
education service sector and in cross sector services of the health and
education sector
Connected to individualism as well as new social roles of individuals family
community and institutions management styles shaped by multi-stakeholder
involvement are gaining importance Community based models do not only increase
the complexity of players involved in the lsquovalue creationrsquo process but also the
enhancement of skill development and personality formation as well as the
fertilization of the educational landscape by innovative ideas expertise and
practices of diverse partners The latter fact also stimulates an increase in cross-
sectoral services (education health and social services) Simultaneously this
situation increases the necessity to spot choose and foster the lsquoinfluencesrsquo and
lsquocombinationsrsquo which realize the highest value through the assessment of social
impact
Increased emphasis is also being placed on illustrating and monitoring
performance Impact measurement and associated tools and practices gain
overarching importance
In terms of changing management styles within the health and education sector an
important aspect is the cooperation of different stakeholders and the involvement
of the community or userrsquos perspective Linked to increased user aspirations
people would like to take part in the development of programs and services With
their special knowledge of their condition for example they can contribute their
expertise within social services
23
5 Other key challenges driving innovation
Sociatal challenges and changes are of course only one driving force of innovation
In addition to these there are other meso and micro level factors which also drive
innovation These include research and development leading to new knowledge
professionally led innovation in response to users needs increasing costs of service
provision and demands for greater efficiency per se and specific political contexts
These other forces are included in the INNOSERV criteria framework in the
lsquochallengesrsquo box These factors are not a key focus for selection of projects for
INNOSERV as they are often very situation specific but will be noted in the case
studies where relevant The factors which prompt or trigger specific innovations
whether socially based or otherwise are not are not mutually exclusive (Bason
2010) and in there is a complex and interacting relationship between a variety of
factors for any given innovation lsquoinstancersquo In addition there are well documented
factors which act to inhibit the development of innovative responses (see Crepaldi
et al 201215)
This work package has sought to identify generic criteria and drivers but it must be
recognised that the dynamics of individual settings and local factors will impact on
the actual processes of adoption
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
24
6 Conclusions and next steps
This report has presented the framework which has been used within the INNOSERV
project to support the choice of innovative case studies and to assist in identifying
the innovation phenomena potential and processes important to future research in
this area The framework has been used to select projects as case studies (see Work
Package 4 report Eurich and Strifler 2012) The framework interlinks aspects of
innovation (novelty type context improvement sustainability) with analysis of
challenges and changes which are acting as driving forces of innovation in social
services As the project is future facing it is proposed that key social challenges
and changes are likely to inform the development of new change paradigms for the
delivery of social services across Europe The framework will inform further
development and testing of concepts through the next stages of the INNOSERVE
programme This process will result in descriptions for the key areas in which future
research on innovation in social services should be taken forward
25
7 Bibliography
Bason C (2010) Leading public sector innovation Co-creating for a better society
Bristol The Policy Press
Bereiter C (2002) Design research for sustained innovation Cognitive Studies
Bulletin of the Japanese Cognitive Society 9 321-327
Christensen CM and Overdorf M (2000) Meeting the Challenge of Disruptive
Change Harvard Business Review March-April
Clark M and Goodwin N (2010) Sustaining innovation in telehealth and telecare
WSDNA briefing paper London The Kings Fund
Crepaldi C De Rosa E And Pesce F (2012) Literature review on innovation in
social services in Europe (sectors of Health Education and Welfare
Services)INNOSERV Work Package 1 report
Department of Health (2011) Innovation Health and Wealth Accelerating Adoption
and Diffusion in the NHS London Department of Health
Eurich J and Strifler A (2012) European compared selection of innovative social
services INNOSERV Work Package 4 report
Fuglsang L (2010) Bricolage and invisible innovation in public service innovation
Journal of Innovation Economics 5 67-87
Greenhalgh T Robert G Macfarlane F Bate P Kyriakidou O (2004) Diffusion of
innovations in service organizations systematic review and recommendations
Milbank Quarterly 82581-629
Hartley J (2005) Innovation in Governance and Public Services Past and Present
Public Money and Management 25127-34
Koch P and Hauknes J (2005) On innovation in the Public Sector Publin report no
D20
Kuhn T (1962) The Structure of Scientific Revolutions Chicago The University of
Chicago Press
Lakatos I and Musgrave A (eds) (1970) Criticism and the growth of knowledge
London Cambridge University Press
May
C Finch T Mair F et al ( 2007) Understanding the implementation of
complex interventions in health care the normalization process model BMC Health
Services Research 2007 7148 doi1011861472-6963-7-148
May et al (2009) Implementing Embedding and Integrating Practices An Outline of
Normalization Process Theory Sociology 43 535-554
Murray R Caulier-Grice J and Mulgan G (2010) The Open Book of Social
Innovation London The Young Foundation
26
OECD (2005) Oslo manual Guidelines for collecting and interpreting innovation
data 3rd
edition
Oliver M (1990) The politics of disablement Basingstoke Macmillan Education Ltd
Osborne S (1998) Naming the Beast Defining and Classifying Service Innovations
in Social Policy Human Relations 51 9 1133-1154
Osborne S and Brown K (2005) Managing Change and Innovation in Public Service
Organizations London Routledge
Phills JA Deiglmeier K and Miller DT (2008) Rediscovering Social Innovation
Stamford Innovation Review 6 4 34-43
Sullivan M (1987) Sociology and Social Welfare London Allen and Unwin
Tidd J and Bessant J (2009) Managing Innovation Integrating Technological
Market and organizational Change 4th
edition Chichester John Wiley and Sons
UK Government Department of Health (2011) Innovation Health and Wealth
Accelerating adoption and diffusion in the NHS London Department of Health
Wolfensburger W (1975) The principle of normalisation in human services Toronto
National Institute on Mental Retardation
27
8 Appendices
Appendix 1 Summary of types and criteria of innovation used in Work Package
3 to identify practices
Identification of social service
Field(s) of service
Logic(s) of service
Self help or mutual aid logic Social care logic Multi-stakeholders logic Social
movements logic Combination
Activities of services delivered
Assistance for persons faced with personal challenges or crises (debt unemployment
drug addiction other) (Re)integration of persons into society (rehabilitation language
training for immigrants other) Services to the labour market (occupational training)
Social housing for disadvantaged groups Care (for the elderly children families )
Treatment and support of people with physical illnesses Treatment and support of
people with mental health problems Combination
Status of the provider organization
Public organization (governmental) Private organization ndash nonnot for profit Private
organization ndash profit Volunteer association Cooperative company or mutual company
Familyneighbourhood Civil society network Combination Other
Target group
Children Youngsters Elder people Unemployed people Poor people Immigrants
Disabled people People with chronic diseases ndash long-term health problems People with
acute or short term health problems No specific target group (eg territory-based social
services provision aiming at strengthen social ties) Combination Other
Size of the organization
Innovation
Type of innovation
New forms of organization resources hybridization new targeted actions new services
non-structural practices other
Innovative character
do the service practices appear to be something new in the field of social services
Origins of innovation
Supply side demand side broader operating factors
Impact on service performance
Effectiveness of service delivery
from user perspective cost effectivenesscapacity building sustainability of
innovation
Quality of provision
28
Socialization quality of life as judged by users and beneficiaries more inclusion
lower risk on exclusion participation of the user transition from institutional to
community based care
Potential wider effects
Promoting social and health equality sustainability new skills and jobs
increased social rights affordability of adequate and high quality health and long-
term care promotion of equality and non-discrimination equal access to adequate
provision
Transferability of innovations between national contexts
29
Appendix 2 levels of innovation identified within INNOSERV Work Package 2
literature review
Organizational level (policy organizational sectors)
New social services designed to face new needs or unmet needs
Search for new solutions to old needs new mechanisms or practices introduced in
preexisting
social services
to improve access to social services (ie more information increased
professionalism in
social work sector)
to guarantee entitlements (rights) for specific groups or minorities
to satisfy the demand for social services in a more complete and broad way
(holistic
approach)
to guarantee more participation and inclusion of citizens
New and increased Cross-Sectoral social services
Cross-Sectoral social services (ie teaching art to children while helping their mothers
for
job seeking and offering jobs for young artists)
Integrated care practices
Tearing down walls between sectors and the role of informal care
Sharing of knowledge
Better integration of Health and Social sector services
Territory based social services that contribute to the creation of training and job
opportunities for disadvantaged people
Solidarity-based social services
Social mediation for impaired and weakened people
Easy access to housing for poor families
New interfaces with clients
Logic(s) of service Self help or mutual aid logic Social care logic Multi-stakeholders
logic
Social movements logic
The development of the self-help sector
Actors New organizations (Cooperative society for social service provision ndashSCOP
Cooperative society as social enterprise with userrsquos involvement ndashSCIC)
New legal forms within structured public frameworks (Italy social cooperatives)
New provider organizations and existing organisations refashioned by new dynamics
New roles and relations among actors
New private organizations for profit and non-profit
Management style in the organization
Regulatory and legislative level
New architecture of the provision system
Socially responsible public contracts and social clauses (outsourcing)
Adherence to EU standards in transitional economies
Impact on institutional framework that shape innovation in social services
New arrangement between one or more government agencies andor external
organization
Organizational level ndash Connection and Cooperation (governance and partnership)
New networks and social movements established in order to design deliver and
finance
social services
Cooperation between sectors actors and different forms of provision
Cooperation between local actors
Increasing communication responsiveness
30
Utilizing connectivity and interdependencies
Modification of organizational systems (models of governance work organisation
number
of involved stakeholders in governance)
Public sector and local authorities as promoters of innovation and promoters of
crosssectoral
policy strategies
Third sector and user as promoters of innovation
Volunteer workers and initiatives launched by a group of citizens
Third sector and userrsquos engagement design (co-design and re-design services)
Joint decision process
Decision-making power not based on capital ownership
Employee and user driven innovation
Partnerships with users family carers and user organizations
Partnership between service users practitioners and academics
Community-based and participative health network in a local territory
Collaboration between public and volunteer organisations (NGOs) or between civil and
local
networks in collaboration with public organisations and social enterprises
New techniques for partnership building and functioning
Impact on social and power relations
Professional level (practitioners)
New practices in social work
Innovative tools (ie Theatre of the Oppressed) and the use of participated methods in
social
work (ie self-help group)
Networking
Individualised supports
New professional skills in social work
The use of informatics and new technologies in social work
Users
Participation and involvement of final users of services in designing delivering and
evaluating social services
Involvement of final users in promoting equality effectiveness and control and
adherence
to the needs of users
Conceptual Level (and value)
New models of society - Social goals participation user involvement community
benefit
New paradigms underlying a new social service concept or service delivery model (ie
new
inclusion paradigm active ageing)
Relationships and trust
Pursuing diversity
Better adjustment to usersrsquo needs more person centred support
More social services provision in less developed regions
New concept of accessibility of the service (ie for Roma families)
The concept of lsquoprogressive universalismrsquo
The Social Care Model
De-institutionalization and community care Improved home-based and community
services
Gender and diversity perspectives
Anti-discrimination and equality process
Increase of the level of recognition of social values objectives paradigms and goals
New models of interaction leading to social innovation processes
31
Public policy level (policy framework programs and social policies)
The new role of the system governance played by central (or local depending on
national
arrangements) government
Impact on public policies new public policy programme measure or intervention
Joint construction of a space for public action and redefinition of public governance
bodies
and methods
Innovative logics for public policies
Innovating the public sector
The new wide attention on anti stigma policies
E-government
Financial and economic sustainability level (and scaling-diffusion-transferability
of innovation)
New ways to overcome budgetary constraints
New approaches to acquire funding
The involvement of private investors
The introduction of special funds
The purchase of innovative practices by final users
Hybridization of resources (market redistribution and reciprocity resources)
New investment sources
Mobilising community resources taking full advantage of all endogenous resources
Improvement in efficiency and effectiveness
Financial and systemic sustainability Impact on the economy
Economic Environmental and Social Sustainability of Territory based social services
Financial tools necessary to territorial social initiatives and the way to unlock them
Capacity of spreading and diffusion
Evaluative level and attention for quality
Affordability availability and accessibility
New standards expected
New feedback loops from users and specialists
Social services of excellence as for quality efficiency and efficacy
New methods and creative tool-kits to strengthen and renew the quality of social care
services
Low-cost (for user) and high level quality of social services
Quality assurance moderation and accreditation mechanisms
New tools for monitoring social services - hearing all voices (users organizations
practioners staff family and friends)
Action research
Alternative economic and social indicators
Social impact and contribution of innovation in social services to social innovation and
social change ndash Assessment of innovation
Learning approach to evaluation ndash lsquoto learn from failuresrsquo
Developmental evaluation
Specifics for the Health sector
Disability from rehabilitation to integration and then to inclusion
Mental Health from segregation to inclusion and community care
HIV from segregationstigmatization to awareness campaigns for promoting self
protection
Innovation in the area of prevention of treatment and in the introduction of new
technologies
Emphasis on an inter-sectoral controlled and steered care in managed care models
replacement of the traditional insurance model
Integrated services
Technological progress
32
Specifics for the Education sector
Inclusive education
Inclusive education and training in collaboration with the civil society
Multicultural education
Integration of disciplines
Alternative schools non-regular schools and informal education
Link between formal and informal education
Community development based approaches
Connection between regular school and the system of social services
Experiential learning
Human rights education
Working lsquothrough relationshipsrsquo with children and young people
Problem based learning methodology
The lsquomedia educationrsquo The use of comics
ICT in schools
E-inclusion
Networks of schools
Improve supplement reinvent and transform learning
Sustained educational improvement
Learning Beyond the Classroom
Spreading a culture that values learning
More personalized approaches to learning
Using the web
Learning with and by not to and from
33
Appendix 3 analysis of social challenges and changes driving innovation
Welfare
Societal
change as
driving force
of innovation
in social
services
Meaning
description
Related
outcomesother
factors
Examples of innovative
responses
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
Empowerment self-
determination choice
The lsquoassertive userrsquo
Demand for more
individualised services of
better quality
Alternativecomplementary
providers
Personalisation
Co-production (new
userprofessional
relationships)
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demand on services
Potential for poor access
to services (from
communication
problems social
isolation)
Multiculturalism
Integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Declining female
caregiving
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
34
Increased demand for
services demand for
formal care
Continued
inequality
Continued
economic
inequality
unemployment
continued poverty
including child
poverty continued
institutionalisation
continued
inequality for
people with
disabilities ethnic
minorities gender
inequalities
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients
with complex
comorbidities increase
in certain diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing demand for
services Increasing
costsneed to make
limited resources go
further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
Decisions about value
marketization
Technological
development
Access to
information new
media technology
Facilitates self
determination increases
expectations and choice
population better
informed about
conditionsservicesright
s and less deferential
Users better able to
35
mobilise
Increased exclusion of
some groups with limited
access
New models of remote
care provision
Ability to exchange
information on quality
and experience
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Increasing costs
Decisions about value
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Organisational
change changing
management
styles
philosophies
Creating new
organisational
forms application
of more responsive
management
processes
performance
management
culture
Integration of
organisationsfunctions
new approaches to
lsquocommissioningrsquo of
organisationsservices
distortions caused by
lsquolocked inrsquo expenditures
(tertiary health care
residential care)
Decentralisation
deinstitutionalisation
marketization liberalisation
The lsquoenabling
statersquo Political
will fiscal space
Impact of financial
crisis competing
priorities for public
funds
Legacy of category-based
(not needs based) social
protection structural
transition
deindustrialisation
Health
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
EmpowermentSelf-
determination choice
Demand for more
individualised services of
better quality
Users better able to mobilise
Assertive lsquouserrsquo
knowledgeable patient
Alternativecomplimentary
providers
36
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demands on
services
Potential for poor access
to services (from
communication
problems social
isolation)
MulticulturalismTrained
health professionals
move to richer countries
integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Declining female
caregiving
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
Increased demand for
formal care services
Continued
inequalities
Unequal
distribution of
health risks and
health
outcomediseases
by socioeconomic
indicators
Unequal access to
care by social
status geography
gender and
ethnicity
Demographic Increase in
numbers of over
Increase in patients with
complex comorbidities
Increasing demand for care
Decisions about value Active
37
change 65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing costsneed to
make limited resources
go further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
ageing paradigm
Technological
development
Access to
information new
media technology
Self determination
expectations choice
population better
informed about
conditionsservicesright
s and less deferential
Ability to exchange
information on quality
and experience
New models of care provision
(eg telehealth care) new
health management systems
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Changing
management
stylesphilosophi
es
Application of
more responsive
management
processes
Decentralisation
deinstitutionalisation
marketization liberalisation
Lifestyle changes Increase in certain
diseases related to
obesity alcohol
and drug
Increasing
costsdemands for care
38
consumption and
stress diabetes
liver disease
anxiety and
depression
Education
Aspirations Rising expectations
by citizens for
better quality of
life
Self determination
choice consumerism
Education outside of formal
setting
Assertive user
Lifelong learningeducation
Migration Historical (post
colonial) migration
pan-EU migration
refugees
New needs for education
eg language and culture
Inequalities social
fragmentation
Social Roles Changing family
structure increase
in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
changing gender
roles rising
female
employment rates
Need to reconcile work
and family life
Parentingfamily skills
for vulnerable
parentsfamilies
Socialization of children
ndash social and emotional
deficits for children in
some environments
Work with families and
communities
Continued
inequalities
Inequality in
educational
accessattainment
by socioeconomic
status gender
people with
disabilities ethnic
minorities
Culture of failure
Promise to deliver social
mobility and economic
improvement
(Leadbeater and Wond
2010 pp 5-20)
Inclusive and multicultural
education
Differential support for
children from
lsquodisadvantagedrsquo
backgrounds
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients with
complex comorbidities
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
New group of older
39
learners
Technological
advance
Access to
information new
media technology
making learning
available in new
ways
Self determination
expectations choice
lsquoAssertive userrsquo
Increased exclusion of
some groups with limited
access
Changing
management
styles
philosophies
Community based models
Globalization Need to provide
educationtraining
which is suited to
modern knowledge
based global
economies
This report for the InnoServ project (grant agreement nr 290542) is supported
under the Socio-economic and Humanities Programme of FP7
Chris Hawker
Faculty of Health Sciences University of Southampton Building 67 University Road Highfield Campus Southampton SO17 1BJ
Tel +44 (0)23 8059 7968
Email CHawkersotonacuk
12
Table 1 Levels of response
Response Definition Example
New service New or improved
product of the scheme
or process
Personalised instead of
generic service
New form of delivery New or improved means
by which the outcome is
achieved
Self-help or social enterprise
instead of government agency
New form of
governance
New or improved way
the scheme or process is
managed and where it
draws authority from
Co-operative or user managed
instead of public service
New form of
resourcing
New or improved
financial human or
physical inputs to the
scheme or process
Grant-funded collectively
staffed organisation instead of
professionally managed
government agency
New way of
evaluation
New or improved
parameters by which
success is judged
User assessment of
effectiveness instead or
professional determined
criteria
It is important to note that innovation within a service is more challenging to define
and measure than innovation in the sense of a product (OECD 2005) while a
product is a tangible entity innovation within service provision can be a either a
product or a process and can occur at different levels of service provision and there
are a number of potential complexities which may inform the structure set out in
table 1
Phills et al (2008) for instance state that social innovation can be
ldquoa product production process or technology (much like innovation in
general) but it can also be a principle an idea a piece of legislation a social
movement an intervention or some combination of themrdquo (39)
In discussing public sector services Hartley (2005) emphasises that innovation is
ldquonot just a new idea but a new practicerdquo (27) and argues therefore that definitions
need to recognise practical impact For services this impact might be at one of
several levels
The organisation literature on innovation offers the initial distinction between
product and process innovation to which other types of innovation have been
added such as position and paradigm innovation (Tidd and Bessant 2009) For
social service oriented innovation further types are added
For example Hartley (2005) identifies the levels of product service process
position strategic governance and rhetorical innovations Hochgerner (2011) adds
social types of innovation to include roles relations norms and values
13
Osborne and Brown (2005) critique a number of typologies to classify innovation
from the management literature They point out that the dichotomy between
process and outcome makes them alternatives whereas an innovation and
particularly innovation in services can be both With services there is often not a
distinct separation between product and process with production delivery and
consumption of services often occurring simultaneously (OECD 2005)
32 Novelty
The next aspect is innovation is novelty In terms of novelty a three way
categorisation is proposed for INNOSERV new perspectives on old needs or
problems new practices for old needs or problems a new practice for a new need
The categorisation reflects the need for innovation to address both existing needs
and new needs Again there is much discussion in the literature about novelty in
relation to innovation Two points are addressed which can be summarised as
lsquowhat degreelevel of novelty equates to innovationrsquo and lsquonew to whomrsquo
The first distinction to be made is between different levels of innovation
ldquoThere are degrees of noveltyrunning from minor incremental
improvements right through to radical changes which transform the way we
think about and use them Sometimes these changes are common to a
particular sector or activity but sometimes they are so radical and far-
reaching that they change the basis of societyhelliprdquo (Tidd and Bessant 2009
27)
Tidd and Bessant usefully break down the incremental-radical continuum as lsquodoing
what we do betterrsquo lsquonew to the enterprisersquo and lsquonew to the worldrsquo (Tidd and
Bessant 2009 38)
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
14
While for some writers a change must be radical or pattern breaking in order to be
innovation it has been argued that within services innovation can be small
adjustments (Fuglsang 2010) Fuglsang in fact argues for a view of innovation in
public sector services as a process of building of skills and expanding routines (68)
The second part of the argument lsquonew to whomrsquo is whether innovation relates to
absolute first use A common to view of innovation is not just those elements
developed within an institution but also those adopted from others (for example
see OECD (2005) for business sector innovation Phills et al (2008) regarding social
innovation Hartley (2005) and Koch (2005) in relation to innovation in public
services) Phills et al (2008) for example state
ldquoAlthough innovations need not necessarily be original they must be new to
the user context or applicationrdquo (Phills et al 37)
Osborne and Brown (2005) purport that most studies consider newness as new to a
person organisation society or situation but not necessarily first use (2005 120)
The authors go on to argue that these are in fact different forms of innovation
differently termed as objective and subjective innovation (Kimberly 1981) or
intrinsic and extrinsic innovation (Downs and Mohr 1976)
Hartley (2005) expounds the dissemination and adaptation of innovation to other
contexts as particularly important for public sector services arguing that public
goals ldquocan be enhanced through collaborative arrangements to create share
transfer adapt and embed good practicerdquo (27) She terms this ldquorsquolateralrsquo innovationrdquo
(33) of good practice adoption and adaption
An example of this approach to defining innovation within social services is seen in
the UK Government policy document on innovation within the National Health
Service which states
ldquoinnovation is as much about applying an idea service or product in a new
context or in a new organisation as it is about creating something newrdquo
(Department of Health 2011 9)
15
33 Hallmarks of innovation
Within social service systems it is not sufficient to focus only on novelty as a
marker of innovation In addition the INNOSERV framework includes certain
hallmarks of innovation including assessment of context quality and sustainability
331 Contextual fit
Different innovative approaches need to fit within different service framework
contexts and need adaptation to those contexts Drawing further on the above
discussion of novelty INNOSERV employ this to mean new to a given (for example
national) context This will reflect the diversity of social service contexts within the
European Union Case studies will also consider transferability of an innovation
from one context to another
332 Improvement in quality
ldquoIn public servicesinnovation is justifiable only where it increases public
value in the quality efficiency or fitness for purpose of governance or
servicesrdquo (Hartley 2005 30)
It is commonly understood that innovation is about improvement as well as novelty
Hartley (2005) offers a model which sets out the possible relationships between
innovation and improvement These relationships are for organisations showing no
improvement and no innovation improvement but no innovation innovation but no
improvement innovation and improvement Important points to highlight from this
model relate to innovation but no improvement first that innovations may not
always lead to success and a level of failure is to be expected second that
innovation can lead to increased but undesired choice loss of performance due to
the process of learning and innovations that are ultimately of no value In terms of
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
16
what is to be measured as improvement Hartley maintains that beyond
improvements in service quality and fitness for purpose wider issues of public
value should be considered
The difficulties of measurement and evaluation of innovation in social services need
to be highlighted as the measures of success within a social project are difficult to
define (Bason 2010 Murray et al 2010) Improvement of social services can
include improved quality of life and access to economic and social opportunity
These issues may relate differently in the fields of health welfare and education
For instance quality of life within health may relate to physical health and mental
wellbeing at different stages of life within welfare issues such as equality of access
to housing cultural and community activities and employment are important
The INNOSERV case studies will include available information on the outcomes of
the innovative project although these will likely vary in terms of types of
measurement used by the projects
333 Sustainability
ldquoInnovation is not just about the originating idea but also the whole process
of the successful development implementation and spread of that idea into
widespread userdquo (Department of Health 2011)
It is recognised that change through innovation needs to be sustainable (Bereiter
2002) Achieving a sustainable innovation may involve streamlining of ideas and
altering them to work in everyday practice (Murray et al 2010 12) The
Normalisation Process Model offered by May and colleagues (May et al 2007 May
et al 2009) provides a theoretical explanation within the context of health care of
the processes through which interventions become embedded in practice and then
integrated and sustained
17
4 Drivers of innovation key societal changes
Innovation within social services needs to be relevant to key social challenges and
changes This relates to the purpose of social services in responding to pressing
social demands and societal needs It is therefore important for the INNOSERV
project to have an understanding of the key social challenges and changes driving
innovation to inform the lsquotheoretical trendsrsquo influencing future innovation
requirements As part of this work package we have therefore sought to identify
social challenges and changes which may act as driving forces of innovation and
shape the development of social service lsquoparadigmsrsquo and hence future social
change
Using a lsquoscenario planningrsquo methodology borrowed from management science can
help to test the limits to any paradigm and identify where new paradigm models
may be needed in the future This in turn should help to identify where future
research interests could be located to explore not just opportunities for innovation
within the current paradigm but also where socially driven change is creating new
opportunities (or indeed requirements) for social and social services innovation
Further these challenges feed into social service provision in terms of an imperative
to address new needs and level of need and issues of rising costs
The INNOSERV project undertook such a scenario planning process the outcomes
of which inform what follows here Using an extended literature study on future
social challenges in the European context a number of key factors promoting a
response from and requiring change in social services were identified Individual
partners made further analysis of the important social challenges within their own
national context The factors were synthesised into a table of key social challenges
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
18
(see appendix 3) separately for health welfare and education sectors although
there was much overlap in the challenges relating to each sector
Small groups involving two country based teams in each case took each social
challenge and considered how it may change and develop given current
understandings of the forces affecting change (some forces may promote change
and some may block change) These were considered against potential political
developments economic developments socialsociological change technological
development legallegislative changes and environmental factors with a focus on
volume nature depth timeframe and scale of importance in influencing future
developments in social services
This work informed extensive discussion at the INNOSERV June 2012 Consortium
meeting with regard to the impact of key future developments on innovation and
the choice of projects which should be used to test key innovation developments
and their relevance to future service development
Relevance is represented in the INNOSERV criteria framework by the lsquodriversrsquo box
which includes a number of examples The most significant social challenges and
changes which were identified by the Consortium as most pertinent to innovation in
social services are listed in table 2 (page 19) and are explored further in the
remainder of this section The selection of projects as case studies has included
analysis of which of these social challenges and changes are being addressed (see
Work Package 4 report Eurich and Strifler 2012)
41 Demographic change as a key societal change driving innovation in the
health and welfare social service sectors
Demographic change was identified as a driving force of innovation in both health
and welfare services in Europe Current demographic change is resulting in
increased numbers of people living longer into old age with a particular increase in
the numbers of people aged over 80 This is alongside a reduction in the numbers
of people of working age in part due to a declining birth rate Further socio-cultural
change is leading to concerns about levels of informal care for older people
While many people will want to live active lives in old age some will live with long
periods of ill health and will have complex care needs resulting from multiple co-
morbidities Most however prefer to live as independently as possible
Questions arise about the ability to meet these increasing care demands from
declining tax income bases In addition the specific needs of elderly patients with
dementia represent a unique challenge for nursing staff and the organisation of
nursing services Financing of the rising health care costs for public agencies or for
health insurance schemes requires sustainable solutions and structural reforms
Traditional models of hospital lsquoacutersquo care may not necessarily be appropriate for
meeting these health care needs
This all highlights the need to find alternative solutions to care needs including the
use of technology and reliance on informal carers Current responses which are
relevant to this driver include integration of health and social care services to
increase cost efficiencies use of technological solutions to enhance self care and
care at home and new paradigms such as Active Ageing
19
Table 2 Key social challenges and changes driving innovation
Social
challengesocial
change driving
innovation
Meaning Social service sector
in which driver is key
Demographic
change
Increase in numbers of over 65s Greatest
increase in over 80 age group Increase in
old age dependency ratio
Health sector
Welfare sector
Aspirations Rising expectations of citizens for better
quality of lifebetter care
Health sector
Education sector
Cross sector services of
education and health
Lifestyles Increase in certain diseases related to
obesity alcohol and drug consumption
and stress diabetes liver disease anxiety
and depression
Health sector
Cross sector services of
education and health
Technology Access to information new media
technology
Health sector
Continued
inequalities
Continued economic inequality
unemployment continued poverty
including child poverty continued
institutionalisation continued inequality for
people with disabilities ethnic minorities
gender inequalities impact of socio-
economic status on health outcomes
Welfare sector
Education sector
Cross sector services of
education and health
and welfare and
education
Independent living The approach now adopted by disabled
people to live as ordinary members of
society and in their chosen domestic
setting
Welfare sector
Social roles Changing families increase in single
households increase in single parent
families changing generational relations
(due to longer life expectancy) reduction in
extended families
Changing gender roles rising female
employment rates
Welfare sector
Education sector
Organisational
changes
Creating new organisational forms
application of more responsive
management processes performance
management culture
Welfare sector
Changing
management
styles
Application of more responsive
management processes
Education sector
Cross sector services of
education and health
20
42 Aspirations as a key societal change driving innovation for health and
for education service sectors
Citizen aspirations were identified as a key societal change acting as a driving force
for innovation within both the health and education sectors and across the
boundary of these sectors Across Europe citizens are expecting a better quality of
life including improved outcomes from health and care services and reduced
inequalities
In terms of the health service sector this both derives from and manifests itself in
a population which is more informed about health issues Consequently patients
wish to be more involved in decisions about their health and their health care
options and are more willing and able to participate in the management of their
condition There is less deference to the medical profession and greater willingness
to make demands on health services There are a growing number of patient led
movements which are challenging some medical traditions
This aspect is fundamental both to everyday practice and to the future development
trajectory for health care services While most health aspirations are limited by
current knowledge and medical skill as research and medical advance offer new
choices and opportunities but at greater costs there will be difficult questions for
political debate This could well result in very different more personalised and
lsquopatient managedrsquo models of health care support
In terms of the education service sector individualism and the connected
aspiration of lsquobeing involvedrsquo has been an increasing trend over the past years and
is expected to keep gaining importance This is not only reflected by agendas of
individually shaped curricula or learning arrangements in school but also by the
opening of the public (ie government funded) school system towards involvement
of the community (seniors in school corporate sponsoring external initiatives of
informal learning and personality formation etc) This is reflected in a similar way
in higher education (eg service learning) and adult education (lsquolearning regionsrsquo)
Across the boundary of health and education aspirations coupled with medical
advance lead to a desire for independence of disabled people and those with long
term conditions This highlights the need for health programs focussed on self
esteem
43 Lifestyles as a key societal challenge driving innovation in the health
service sector and also in the cross sector services of health and education
A key social challenge acting as a driving force for innovation for the health sector
and in the cross sector services of education and health is a recognised growth in
lsquolifestylersquo related conditions arising from unhealthy behaviours such as poor diet
alcohol consumption and smoking (although there is limited evidence of a decline
in smoking rates as its harmful effects are less well tolerated) Political investment
in public health is recognised as an important strategic ambition but often not
matched by financial resources Questions about personal responsibility are also
being asked with suggestions that people with poor health behaviours should not
be given the same priority to responsive health care services As other factors
impacting on health outcomes become more responsive to medical advance these
factors are growing in importance in their impact both on wider society and in
improving overall health outcomes
21
44 Technology as a key societal change driving innovation in the health
service sector
The growth in internet and web based technology is leading to an exponential
growth in access to information and new forms of communication More people
now use the internet as their primary health care information resource Web
lsquocommunitiesrsquo are linking and thus empowering people faced with similar health
challenges Telehealthcare solutions to on-going care needs are becoming more
widely available and are changing the patterns of demands for some health care
services Other new technologies for example in transport and in home assistance
devices are enabling greater independence for disabled people
As future generations use and expect more from access to information and
communication services health care services will have to respond to both the
demands and the opportunities created by such technology Technology can be
seen as both a driving force for innovation and as an enabler of change
45 Continued inequalities as a key societal challenge driving innovation in
welfare and education service sectors also in cross sector services of
education and health and welfare and education
Continued inequalities were identified as a key driving force for innovation within
both welfare and education sectors and in services which straddle the boundary
between education and health services and education and welfare services
Inequalities stem from issues of migration social originbackground
unemployment disability and gender and have been a source of the social
upheaval which has been seen in Europe in recent months
Within health education the link between socio-economic status and health is clear
with people from lower socio-economic groups experiencing poorer health and less
likely engaging in health promoting behaviours In the case of migrants health
messages need to be delivered in a culturally appropriate manner
46 Independent living as a key societal change driving innovation in the
welfare service sector
In terms of disability the emergence and spread of the independent living
philosophy has been a key change driving innovation in the welfare service sector
Typically innovation in this field involves new stakeholder roles with a much more
proactive role for service users in all stages of service provision design
implementation monitoring and fine tuning of services as well as a role in
coordination of different entitlementsservices andor administration and reporting
requirements The boundaries are being pushed further deeper and wider every
day Starting from persons with physical disabilities services are now promoting
active involvement of persons with severe mental disabilities a development that
was deemed impossible only 30 years ago
47 Social roles as a key societal change driving innovation for welfare and
for education service sectors
Changing social roles were identified as a key challenge driving innovation within
the welfare and education sectors These changes are within families and of the
family itself and include changing gender roles and changing family structures (eg
increase in single parent families increase in the numbers of older people living
alone) Families seem to be becoming a sphere of public or community interest
rather than an exclusively private one
Proper lsquosocializationrsquo of children is the key to building viable and sustainable
futures for individuals Early stage family intervention is necessary to prevent the
22
very emergence of conflicts lsquoExternalrsquo interventions often do not reach every day
interaction and thus the root causes of problems This is of significance for family
based projects as well as for care institutions and education providers
48 Organisational changes as a key societal change driving innovation in
welfare service sectors
The shifting of provision of services from the public sector into other sectors such
as independent profit making companies and social enterprises creates new
opportunities for innovation In addition there is an increasing move to provide
services locally in order to be more relevant and responsive and a move to
community based models of care
49 Changing management styles as a key innovation challenge for the
education service sector and in cross sector services of the health and
education sector
Connected to individualism as well as new social roles of individuals family
community and institutions management styles shaped by multi-stakeholder
involvement are gaining importance Community based models do not only increase
the complexity of players involved in the lsquovalue creationrsquo process but also the
enhancement of skill development and personality formation as well as the
fertilization of the educational landscape by innovative ideas expertise and
practices of diverse partners The latter fact also stimulates an increase in cross-
sectoral services (education health and social services) Simultaneously this
situation increases the necessity to spot choose and foster the lsquoinfluencesrsquo and
lsquocombinationsrsquo which realize the highest value through the assessment of social
impact
Increased emphasis is also being placed on illustrating and monitoring
performance Impact measurement and associated tools and practices gain
overarching importance
In terms of changing management styles within the health and education sector an
important aspect is the cooperation of different stakeholders and the involvement
of the community or userrsquos perspective Linked to increased user aspirations
people would like to take part in the development of programs and services With
their special knowledge of their condition for example they can contribute their
expertise within social services
23
5 Other key challenges driving innovation
Sociatal challenges and changes are of course only one driving force of innovation
In addition to these there are other meso and micro level factors which also drive
innovation These include research and development leading to new knowledge
professionally led innovation in response to users needs increasing costs of service
provision and demands for greater efficiency per se and specific political contexts
These other forces are included in the INNOSERV criteria framework in the
lsquochallengesrsquo box These factors are not a key focus for selection of projects for
INNOSERV as they are often very situation specific but will be noted in the case
studies where relevant The factors which prompt or trigger specific innovations
whether socially based or otherwise are not are not mutually exclusive (Bason
2010) and in there is a complex and interacting relationship between a variety of
factors for any given innovation lsquoinstancersquo In addition there are well documented
factors which act to inhibit the development of innovative responses (see Crepaldi
et al 201215)
This work package has sought to identify generic criteria and drivers but it must be
recognised that the dynamics of individual settings and local factors will impact on
the actual processes of adoption
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
24
6 Conclusions and next steps
This report has presented the framework which has been used within the INNOSERV
project to support the choice of innovative case studies and to assist in identifying
the innovation phenomena potential and processes important to future research in
this area The framework has been used to select projects as case studies (see Work
Package 4 report Eurich and Strifler 2012) The framework interlinks aspects of
innovation (novelty type context improvement sustainability) with analysis of
challenges and changes which are acting as driving forces of innovation in social
services As the project is future facing it is proposed that key social challenges
and changes are likely to inform the development of new change paradigms for the
delivery of social services across Europe The framework will inform further
development and testing of concepts through the next stages of the INNOSERVE
programme This process will result in descriptions for the key areas in which future
research on innovation in social services should be taken forward
25
7 Bibliography
Bason C (2010) Leading public sector innovation Co-creating for a better society
Bristol The Policy Press
Bereiter C (2002) Design research for sustained innovation Cognitive Studies
Bulletin of the Japanese Cognitive Society 9 321-327
Christensen CM and Overdorf M (2000) Meeting the Challenge of Disruptive
Change Harvard Business Review March-April
Clark M and Goodwin N (2010) Sustaining innovation in telehealth and telecare
WSDNA briefing paper London The Kings Fund
Crepaldi C De Rosa E And Pesce F (2012) Literature review on innovation in
social services in Europe (sectors of Health Education and Welfare
Services)INNOSERV Work Package 1 report
Department of Health (2011) Innovation Health and Wealth Accelerating Adoption
and Diffusion in the NHS London Department of Health
Eurich J and Strifler A (2012) European compared selection of innovative social
services INNOSERV Work Package 4 report
Fuglsang L (2010) Bricolage and invisible innovation in public service innovation
Journal of Innovation Economics 5 67-87
Greenhalgh T Robert G Macfarlane F Bate P Kyriakidou O (2004) Diffusion of
innovations in service organizations systematic review and recommendations
Milbank Quarterly 82581-629
Hartley J (2005) Innovation in Governance and Public Services Past and Present
Public Money and Management 25127-34
Koch P and Hauknes J (2005) On innovation in the Public Sector Publin report no
D20
Kuhn T (1962) The Structure of Scientific Revolutions Chicago The University of
Chicago Press
Lakatos I and Musgrave A (eds) (1970) Criticism and the growth of knowledge
London Cambridge University Press
May
C Finch T Mair F et al ( 2007) Understanding the implementation of
complex interventions in health care the normalization process model BMC Health
Services Research 2007 7148 doi1011861472-6963-7-148
May et al (2009) Implementing Embedding and Integrating Practices An Outline of
Normalization Process Theory Sociology 43 535-554
Murray R Caulier-Grice J and Mulgan G (2010) The Open Book of Social
Innovation London The Young Foundation
26
OECD (2005) Oslo manual Guidelines for collecting and interpreting innovation
data 3rd
edition
Oliver M (1990) The politics of disablement Basingstoke Macmillan Education Ltd
Osborne S (1998) Naming the Beast Defining and Classifying Service Innovations
in Social Policy Human Relations 51 9 1133-1154
Osborne S and Brown K (2005) Managing Change and Innovation in Public Service
Organizations London Routledge
Phills JA Deiglmeier K and Miller DT (2008) Rediscovering Social Innovation
Stamford Innovation Review 6 4 34-43
Sullivan M (1987) Sociology and Social Welfare London Allen and Unwin
Tidd J and Bessant J (2009) Managing Innovation Integrating Technological
Market and organizational Change 4th
edition Chichester John Wiley and Sons
UK Government Department of Health (2011) Innovation Health and Wealth
Accelerating adoption and diffusion in the NHS London Department of Health
Wolfensburger W (1975) The principle of normalisation in human services Toronto
National Institute on Mental Retardation
27
8 Appendices
Appendix 1 Summary of types and criteria of innovation used in Work Package
3 to identify practices
Identification of social service
Field(s) of service
Logic(s) of service
Self help or mutual aid logic Social care logic Multi-stakeholders logic Social
movements logic Combination
Activities of services delivered
Assistance for persons faced with personal challenges or crises (debt unemployment
drug addiction other) (Re)integration of persons into society (rehabilitation language
training for immigrants other) Services to the labour market (occupational training)
Social housing for disadvantaged groups Care (for the elderly children families )
Treatment and support of people with physical illnesses Treatment and support of
people with mental health problems Combination
Status of the provider organization
Public organization (governmental) Private organization ndash nonnot for profit Private
organization ndash profit Volunteer association Cooperative company or mutual company
Familyneighbourhood Civil society network Combination Other
Target group
Children Youngsters Elder people Unemployed people Poor people Immigrants
Disabled people People with chronic diseases ndash long-term health problems People with
acute or short term health problems No specific target group (eg territory-based social
services provision aiming at strengthen social ties) Combination Other
Size of the organization
Innovation
Type of innovation
New forms of organization resources hybridization new targeted actions new services
non-structural practices other
Innovative character
do the service practices appear to be something new in the field of social services
Origins of innovation
Supply side demand side broader operating factors
Impact on service performance
Effectiveness of service delivery
from user perspective cost effectivenesscapacity building sustainability of
innovation
Quality of provision
28
Socialization quality of life as judged by users and beneficiaries more inclusion
lower risk on exclusion participation of the user transition from institutional to
community based care
Potential wider effects
Promoting social and health equality sustainability new skills and jobs
increased social rights affordability of adequate and high quality health and long-
term care promotion of equality and non-discrimination equal access to adequate
provision
Transferability of innovations between national contexts
29
Appendix 2 levels of innovation identified within INNOSERV Work Package 2
literature review
Organizational level (policy organizational sectors)
New social services designed to face new needs or unmet needs
Search for new solutions to old needs new mechanisms or practices introduced in
preexisting
social services
to improve access to social services (ie more information increased
professionalism in
social work sector)
to guarantee entitlements (rights) for specific groups or minorities
to satisfy the demand for social services in a more complete and broad way
(holistic
approach)
to guarantee more participation and inclusion of citizens
New and increased Cross-Sectoral social services
Cross-Sectoral social services (ie teaching art to children while helping their mothers
for
job seeking and offering jobs for young artists)
Integrated care practices
Tearing down walls between sectors and the role of informal care
Sharing of knowledge
Better integration of Health and Social sector services
Territory based social services that contribute to the creation of training and job
opportunities for disadvantaged people
Solidarity-based social services
Social mediation for impaired and weakened people
Easy access to housing for poor families
New interfaces with clients
Logic(s) of service Self help or mutual aid logic Social care logic Multi-stakeholders
logic
Social movements logic
The development of the self-help sector
Actors New organizations (Cooperative society for social service provision ndashSCOP
Cooperative society as social enterprise with userrsquos involvement ndashSCIC)
New legal forms within structured public frameworks (Italy social cooperatives)
New provider organizations and existing organisations refashioned by new dynamics
New roles and relations among actors
New private organizations for profit and non-profit
Management style in the organization
Regulatory and legislative level
New architecture of the provision system
Socially responsible public contracts and social clauses (outsourcing)
Adherence to EU standards in transitional economies
Impact on institutional framework that shape innovation in social services
New arrangement between one or more government agencies andor external
organization
Organizational level ndash Connection and Cooperation (governance and partnership)
New networks and social movements established in order to design deliver and
finance
social services
Cooperation between sectors actors and different forms of provision
Cooperation between local actors
Increasing communication responsiveness
30
Utilizing connectivity and interdependencies
Modification of organizational systems (models of governance work organisation
number
of involved stakeholders in governance)
Public sector and local authorities as promoters of innovation and promoters of
crosssectoral
policy strategies
Third sector and user as promoters of innovation
Volunteer workers and initiatives launched by a group of citizens
Third sector and userrsquos engagement design (co-design and re-design services)
Joint decision process
Decision-making power not based on capital ownership
Employee and user driven innovation
Partnerships with users family carers and user organizations
Partnership between service users practitioners and academics
Community-based and participative health network in a local territory
Collaboration between public and volunteer organisations (NGOs) or between civil and
local
networks in collaboration with public organisations and social enterprises
New techniques for partnership building and functioning
Impact on social and power relations
Professional level (practitioners)
New practices in social work
Innovative tools (ie Theatre of the Oppressed) and the use of participated methods in
social
work (ie self-help group)
Networking
Individualised supports
New professional skills in social work
The use of informatics and new technologies in social work
Users
Participation and involvement of final users of services in designing delivering and
evaluating social services
Involvement of final users in promoting equality effectiveness and control and
adherence
to the needs of users
Conceptual Level (and value)
New models of society - Social goals participation user involvement community
benefit
New paradigms underlying a new social service concept or service delivery model (ie
new
inclusion paradigm active ageing)
Relationships and trust
Pursuing diversity
Better adjustment to usersrsquo needs more person centred support
More social services provision in less developed regions
New concept of accessibility of the service (ie for Roma families)
The concept of lsquoprogressive universalismrsquo
The Social Care Model
De-institutionalization and community care Improved home-based and community
services
Gender and diversity perspectives
Anti-discrimination and equality process
Increase of the level of recognition of social values objectives paradigms and goals
New models of interaction leading to social innovation processes
31
Public policy level (policy framework programs and social policies)
The new role of the system governance played by central (or local depending on
national
arrangements) government
Impact on public policies new public policy programme measure or intervention
Joint construction of a space for public action and redefinition of public governance
bodies
and methods
Innovative logics for public policies
Innovating the public sector
The new wide attention on anti stigma policies
E-government
Financial and economic sustainability level (and scaling-diffusion-transferability
of innovation)
New ways to overcome budgetary constraints
New approaches to acquire funding
The involvement of private investors
The introduction of special funds
The purchase of innovative practices by final users
Hybridization of resources (market redistribution and reciprocity resources)
New investment sources
Mobilising community resources taking full advantage of all endogenous resources
Improvement in efficiency and effectiveness
Financial and systemic sustainability Impact on the economy
Economic Environmental and Social Sustainability of Territory based social services
Financial tools necessary to territorial social initiatives and the way to unlock them
Capacity of spreading and diffusion
Evaluative level and attention for quality
Affordability availability and accessibility
New standards expected
New feedback loops from users and specialists
Social services of excellence as for quality efficiency and efficacy
New methods and creative tool-kits to strengthen and renew the quality of social care
services
Low-cost (for user) and high level quality of social services
Quality assurance moderation and accreditation mechanisms
New tools for monitoring social services - hearing all voices (users organizations
practioners staff family and friends)
Action research
Alternative economic and social indicators
Social impact and contribution of innovation in social services to social innovation and
social change ndash Assessment of innovation
Learning approach to evaluation ndash lsquoto learn from failuresrsquo
Developmental evaluation
Specifics for the Health sector
Disability from rehabilitation to integration and then to inclusion
Mental Health from segregation to inclusion and community care
HIV from segregationstigmatization to awareness campaigns for promoting self
protection
Innovation in the area of prevention of treatment and in the introduction of new
technologies
Emphasis on an inter-sectoral controlled and steered care in managed care models
replacement of the traditional insurance model
Integrated services
Technological progress
32
Specifics for the Education sector
Inclusive education
Inclusive education and training in collaboration with the civil society
Multicultural education
Integration of disciplines
Alternative schools non-regular schools and informal education
Link between formal and informal education
Community development based approaches
Connection between regular school and the system of social services
Experiential learning
Human rights education
Working lsquothrough relationshipsrsquo with children and young people
Problem based learning methodology
The lsquomedia educationrsquo The use of comics
ICT in schools
E-inclusion
Networks of schools
Improve supplement reinvent and transform learning
Sustained educational improvement
Learning Beyond the Classroom
Spreading a culture that values learning
More personalized approaches to learning
Using the web
Learning with and by not to and from
33
Appendix 3 analysis of social challenges and changes driving innovation
Welfare
Societal
change as
driving force
of innovation
in social
services
Meaning
description
Related
outcomesother
factors
Examples of innovative
responses
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
Empowerment self-
determination choice
The lsquoassertive userrsquo
Demand for more
individualised services of
better quality
Alternativecomplementary
providers
Personalisation
Co-production (new
userprofessional
relationships)
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demand on services
Potential for poor access
to services (from
communication
problems social
isolation)
Multiculturalism
Integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Declining female
caregiving
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
34
Increased demand for
services demand for
formal care
Continued
inequality
Continued
economic
inequality
unemployment
continued poverty
including child
poverty continued
institutionalisation
continued
inequality for
people with
disabilities ethnic
minorities gender
inequalities
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients
with complex
comorbidities increase
in certain diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing demand for
services Increasing
costsneed to make
limited resources go
further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
Decisions about value
marketization
Technological
development
Access to
information new
media technology
Facilitates self
determination increases
expectations and choice
population better
informed about
conditionsservicesright
s and less deferential
Users better able to
35
mobilise
Increased exclusion of
some groups with limited
access
New models of remote
care provision
Ability to exchange
information on quality
and experience
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Increasing costs
Decisions about value
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Organisational
change changing
management
styles
philosophies
Creating new
organisational
forms application
of more responsive
management
processes
performance
management
culture
Integration of
organisationsfunctions
new approaches to
lsquocommissioningrsquo of
organisationsservices
distortions caused by
lsquolocked inrsquo expenditures
(tertiary health care
residential care)
Decentralisation
deinstitutionalisation
marketization liberalisation
The lsquoenabling
statersquo Political
will fiscal space
Impact of financial
crisis competing
priorities for public
funds
Legacy of category-based
(not needs based) social
protection structural
transition
deindustrialisation
Health
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
EmpowermentSelf-
determination choice
Demand for more
individualised services of
better quality
Users better able to mobilise
Assertive lsquouserrsquo
knowledgeable patient
Alternativecomplimentary
providers
36
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demands on
services
Potential for poor access
to services (from
communication
problems social
isolation)
MulticulturalismTrained
health professionals
move to richer countries
integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Declining female
caregiving
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
Increased demand for
formal care services
Continued
inequalities
Unequal
distribution of
health risks and
health
outcomediseases
by socioeconomic
indicators
Unequal access to
care by social
status geography
gender and
ethnicity
Demographic Increase in
numbers of over
Increase in patients with
complex comorbidities
Increasing demand for care
Decisions about value Active
37
change 65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing costsneed to
make limited resources
go further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
ageing paradigm
Technological
development
Access to
information new
media technology
Self determination
expectations choice
population better
informed about
conditionsservicesright
s and less deferential
Ability to exchange
information on quality
and experience
New models of care provision
(eg telehealth care) new
health management systems
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Changing
management
stylesphilosophi
es
Application of
more responsive
management
processes
Decentralisation
deinstitutionalisation
marketization liberalisation
Lifestyle changes Increase in certain
diseases related to
obesity alcohol
and drug
Increasing
costsdemands for care
38
consumption and
stress diabetes
liver disease
anxiety and
depression
Education
Aspirations Rising expectations
by citizens for
better quality of
life
Self determination
choice consumerism
Education outside of formal
setting
Assertive user
Lifelong learningeducation
Migration Historical (post
colonial) migration
pan-EU migration
refugees
New needs for education
eg language and culture
Inequalities social
fragmentation
Social Roles Changing family
structure increase
in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
changing gender
roles rising
female
employment rates
Need to reconcile work
and family life
Parentingfamily skills
for vulnerable
parentsfamilies
Socialization of children
ndash social and emotional
deficits for children in
some environments
Work with families and
communities
Continued
inequalities
Inequality in
educational
accessattainment
by socioeconomic
status gender
people with
disabilities ethnic
minorities
Culture of failure
Promise to deliver social
mobility and economic
improvement
(Leadbeater and Wond
2010 pp 5-20)
Inclusive and multicultural
education
Differential support for
children from
lsquodisadvantagedrsquo
backgrounds
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients with
complex comorbidities
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
New group of older
39
learners
Technological
advance
Access to
information new
media technology
making learning
available in new
ways
Self determination
expectations choice
lsquoAssertive userrsquo
Increased exclusion of
some groups with limited
access
Changing
management
styles
philosophies
Community based models
Globalization Need to provide
educationtraining
which is suited to
modern knowledge
based global
economies
This report for the InnoServ project (grant agreement nr 290542) is supported
under the Socio-economic and Humanities Programme of FP7
Chris Hawker
Faculty of Health Sciences University of Southampton Building 67 University Road Highfield Campus Southampton SO17 1BJ
Tel +44 (0)23 8059 7968
Email CHawkersotonacuk
13
Osborne and Brown (2005) critique a number of typologies to classify innovation
from the management literature They point out that the dichotomy between
process and outcome makes them alternatives whereas an innovation and
particularly innovation in services can be both With services there is often not a
distinct separation between product and process with production delivery and
consumption of services often occurring simultaneously (OECD 2005)
32 Novelty
The next aspect is innovation is novelty In terms of novelty a three way
categorisation is proposed for INNOSERV new perspectives on old needs or
problems new practices for old needs or problems a new practice for a new need
The categorisation reflects the need for innovation to address both existing needs
and new needs Again there is much discussion in the literature about novelty in
relation to innovation Two points are addressed which can be summarised as
lsquowhat degreelevel of novelty equates to innovationrsquo and lsquonew to whomrsquo
The first distinction to be made is between different levels of innovation
ldquoThere are degrees of noveltyrunning from minor incremental
improvements right through to radical changes which transform the way we
think about and use them Sometimes these changes are common to a
particular sector or activity but sometimes they are so radical and far-
reaching that they change the basis of societyhelliprdquo (Tidd and Bessant 2009
27)
Tidd and Bessant usefully break down the incremental-radical continuum as lsquodoing
what we do betterrsquo lsquonew to the enterprisersquo and lsquonew to the worldrsquo (Tidd and
Bessant 2009 38)
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
14
While for some writers a change must be radical or pattern breaking in order to be
innovation it has been argued that within services innovation can be small
adjustments (Fuglsang 2010) Fuglsang in fact argues for a view of innovation in
public sector services as a process of building of skills and expanding routines (68)
The second part of the argument lsquonew to whomrsquo is whether innovation relates to
absolute first use A common to view of innovation is not just those elements
developed within an institution but also those adopted from others (for example
see OECD (2005) for business sector innovation Phills et al (2008) regarding social
innovation Hartley (2005) and Koch (2005) in relation to innovation in public
services) Phills et al (2008) for example state
ldquoAlthough innovations need not necessarily be original they must be new to
the user context or applicationrdquo (Phills et al 37)
Osborne and Brown (2005) purport that most studies consider newness as new to a
person organisation society or situation but not necessarily first use (2005 120)
The authors go on to argue that these are in fact different forms of innovation
differently termed as objective and subjective innovation (Kimberly 1981) or
intrinsic and extrinsic innovation (Downs and Mohr 1976)
Hartley (2005) expounds the dissemination and adaptation of innovation to other
contexts as particularly important for public sector services arguing that public
goals ldquocan be enhanced through collaborative arrangements to create share
transfer adapt and embed good practicerdquo (27) She terms this ldquorsquolateralrsquo innovationrdquo
(33) of good practice adoption and adaption
An example of this approach to defining innovation within social services is seen in
the UK Government policy document on innovation within the National Health
Service which states
ldquoinnovation is as much about applying an idea service or product in a new
context or in a new organisation as it is about creating something newrdquo
(Department of Health 2011 9)
15
33 Hallmarks of innovation
Within social service systems it is not sufficient to focus only on novelty as a
marker of innovation In addition the INNOSERV framework includes certain
hallmarks of innovation including assessment of context quality and sustainability
331 Contextual fit
Different innovative approaches need to fit within different service framework
contexts and need adaptation to those contexts Drawing further on the above
discussion of novelty INNOSERV employ this to mean new to a given (for example
national) context This will reflect the diversity of social service contexts within the
European Union Case studies will also consider transferability of an innovation
from one context to another
332 Improvement in quality
ldquoIn public servicesinnovation is justifiable only where it increases public
value in the quality efficiency or fitness for purpose of governance or
servicesrdquo (Hartley 2005 30)
It is commonly understood that innovation is about improvement as well as novelty
Hartley (2005) offers a model which sets out the possible relationships between
innovation and improvement These relationships are for organisations showing no
improvement and no innovation improvement but no innovation innovation but no
improvement innovation and improvement Important points to highlight from this
model relate to innovation but no improvement first that innovations may not
always lead to success and a level of failure is to be expected second that
innovation can lead to increased but undesired choice loss of performance due to
the process of learning and innovations that are ultimately of no value In terms of
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
16
what is to be measured as improvement Hartley maintains that beyond
improvements in service quality and fitness for purpose wider issues of public
value should be considered
The difficulties of measurement and evaluation of innovation in social services need
to be highlighted as the measures of success within a social project are difficult to
define (Bason 2010 Murray et al 2010) Improvement of social services can
include improved quality of life and access to economic and social opportunity
These issues may relate differently in the fields of health welfare and education
For instance quality of life within health may relate to physical health and mental
wellbeing at different stages of life within welfare issues such as equality of access
to housing cultural and community activities and employment are important
The INNOSERV case studies will include available information on the outcomes of
the innovative project although these will likely vary in terms of types of
measurement used by the projects
333 Sustainability
ldquoInnovation is not just about the originating idea but also the whole process
of the successful development implementation and spread of that idea into
widespread userdquo (Department of Health 2011)
It is recognised that change through innovation needs to be sustainable (Bereiter
2002) Achieving a sustainable innovation may involve streamlining of ideas and
altering them to work in everyday practice (Murray et al 2010 12) The
Normalisation Process Model offered by May and colleagues (May et al 2007 May
et al 2009) provides a theoretical explanation within the context of health care of
the processes through which interventions become embedded in practice and then
integrated and sustained
17
4 Drivers of innovation key societal changes
Innovation within social services needs to be relevant to key social challenges and
changes This relates to the purpose of social services in responding to pressing
social demands and societal needs It is therefore important for the INNOSERV
project to have an understanding of the key social challenges and changes driving
innovation to inform the lsquotheoretical trendsrsquo influencing future innovation
requirements As part of this work package we have therefore sought to identify
social challenges and changes which may act as driving forces of innovation and
shape the development of social service lsquoparadigmsrsquo and hence future social
change
Using a lsquoscenario planningrsquo methodology borrowed from management science can
help to test the limits to any paradigm and identify where new paradigm models
may be needed in the future This in turn should help to identify where future
research interests could be located to explore not just opportunities for innovation
within the current paradigm but also where socially driven change is creating new
opportunities (or indeed requirements) for social and social services innovation
Further these challenges feed into social service provision in terms of an imperative
to address new needs and level of need and issues of rising costs
The INNOSERV project undertook such a scenario planning process the outcomes
of which inform what follows here Using an extended literature study on future
social challenges in the European context a number of key factors promoting a
response from and requiring change in social services were identified Individual
partners made further analysis of the important social challenges within their own
national context The factors were synthesised into a table of key social challenges
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
18
(see appendix 3) separately for health welfare and education sectors although
there was much overlap in the challenges relating to each sector
Small groups involving two country based teams in each case took each social
challenge and considered how it may change and develop given current
understandings of the forces affecting change (some forces may promote change
and some may block change) These were considered against potential political
developments economic developments socialsociological change technological
development legallegislative changes and environmental factors with a focus on
volume nature depth timeframe and scale of importance in influencing future
developments in social services
This work informed extensive discussion at the INNOSERV June 2012 Consortium
meeting with regard to the impact of key future developments on innovation and
the choice of projects which should be used to test key innovation developments
and their relevance to future service development
Relevance is represented in the INNOSERV criteria framework by the lsquodriversrsquo box
which includes a number of examples The most significant social challenges and
changes which were identified by the Consortium as most pertinent to innovation in
social services are listed in table 2 (page 19) and are explored further in the
remainder of this section The selection of projects as case studies has included
analysis of which of these social challenges and changes are being addressed (see
Work Package 4 report Eurich and Strifler 2012)
41 Demographic change as a key societal change driving innovation in the
health and welfare social service sectors
Demographic change was identified as a driving force of innovation in both health
and welfare services in Europe Current demographic change is resulting in
increased numbers of people living longer into old age with a particular increase in
the numbers of people aged over 80 This is alongside a reduction in the numbers
of people of working age in part due to a declining birth rate Further socio-cultural
change is leading to concerns about levels of informal care for older people
While many people will want to live active lives in old age some will live with long
periods of ill health and will have complex care needs resulting from multiple co-
morbidities Most however prefer to live as independently as possible
Questions arise about the ability to meet these increasing care demands from
declining tax income bases In addition the specific needs of elderly patients with
dementia represent a unique challenge for nursing staff and the organisation of
nursing services Financing of the rising health care costs for public agencies or for
health insurance schemes requires sustainable solutions and structural reforms
Traditional models of hospital lsquoacutersquo care may not necessarily be appropriate for
meeting these health care needs
This all highlights the need to find alternative solutions to care needs including the
use of technology and reliance on informal carers Current responses which are
relevant to this driver include integration of health and social care services to
increase cost efficiencies use of technological solutions to enhance self care and
care at home and new paradigms such as Active Ageing
19
Table 2 Key social challenges and changes driving innovation
Social
challengesocial
change driving
innovation
Meaning Social service sector
in which driver is key
Demographic
change
Increase in numbers of over 65s Greatest
increase in over 80 age group Increase in
old age dependency ratio
Health sector
Welfare sector
Aspirations Rising expectations of citizens for better
quality of lifebetter care
Health sector
Education sector
Cross sector services of
education and health
Lifestyles Increase in certain diseases related to
obesity alcohol and drug consumption
and stress diabetes liver disease anxiety
and depression
Health sector
Cross sector services of
education and health
Technology Access to information new media
technology
Health sector
Continued
inequalities
Continued economic inequality
unemployment continued poverty
including child poverty continued
institutionalisation continued inequality for
people with disabilities ethnic minorities
gender inequalities impact of socio-
economic status on health outcomes
Welfare sector
Education sector
Cross sector services of
education and health
and welfare and
education
Independent living The approach now adopted by disabled
people to live as ordinary members of
society and in their chosen domestic
setting
Welfare sector
Social roles Changing families increase in single
households increase in single parent
families changing generational relations
(due to longer life expectancy) reduction in
extended families
Changing gender roles rising female
employment rates
Welfare sector
Education sector
Organisational
changes
Creating new organisational forms
application of more responsive
management processes performance
management culture
Welfare sector
Changing
management
styles
Application of more responsive
management processes
Education sector
Cross sector services of
education and health
20
42 Aspirations as a key societal change driving innovation for health and
for education service sectors
Citizen aspirations were identified as a key societal change acting as a driving force
for innovation within both the health and education sectors and across the
boundary of these sectors Across Europe citizens are expecting a better quality of
life including improved outcomes from health and care services and reduced
inequalities
In terms of the health service sector this both derives from and manifests itself in
a population which is more informed about health issues Consequently patients
wish to be more involved in decisions about their health and their health care
options and are more willing and able to participate in the management of their
condition There is less deference to the medical profession and greater willingness
to make demands on health services There are a growing number of patient led
movements which are challenging some medical traditions
This aspect is fundamental both to everyday practice and to the future development
trajectory for health care services While most health aspirations are limited by
current knowledge and medical skill as research and medical advance offer new
choices and opportunities but at greater costs there will be difficult questions for
political debate This could well result in very different more personalised and
lsquopatient managedrsquo models of health care support
In terms of the education service sector individualism and the connected
aspiration of lsquobeing involvedrsquo has been an increasing trend over the past years and
is expected to keep gaining importance This is not only reflected by agendas of
individually shaped curricula or learning arrangements in school but also by the
opening of the public (ie government funded) school system towards involvement
of the community (seniors in school corporate sponsoring external initiatives of
informal learning and personality formation etc) This is reflected in a similar way
in higher education (eg service learning) and adult education (lsquolearning regionsrsquo)
Across the boundary of health and education aspirations coupled with medical
advance lead to a desire for independence of disabled people and those with long
term conditions This highlights the need for health programs focussed on self
esteem
43 Lifestyles as a key societal challenge driving innovation in the health
service sector and also in the cross sector services of health and education
A key social challenge acting as a driving force for innovation for the health sector
and in the cross sector services of education and health is a recognised growth in
lsquolifestylersquo related conditions arising from unhealthy behaviours such as poor diet
alcohol consumption and smoking (although there is limited evidence of a decline
in smoking rates as its harmful effects are less well tolerated) Political investment
in public health is recognised as an important strategic ambition but often not
matched by financial resources Questions about personal responsibility are also
being asked with suggestions that people with poor health behaviours should not
be given the same priority to responsive health care services As other factors
impacting on health outcomes become more responsive to medical advance these
factors are growing in importance in their impact both on wider society and in
improving overall health outcomes
21
44 Technology as a key societal change driving innovation in the health
service sector
The growth in internet and web based technology is leading to an exponential
growth in access to information and new forms of communication More people
now use the internet as their primary health care information resource Web
lsquocommunitiesrsquo are linking and thus empowering people faced with similar health
challenges Telehealthcare solutions to on-going care needs are becoming more
widely available and are changing the patterns of demands for some health care
services Other new technologies for example in transport and in home assistance
devices are enabling greater independence for disabled people
As future generations use and expect more from access to information and
communication services health care services will have to respond to both the
demands and the opportunities created by such technology Technology can be
seen as both a driving force for innovation and as an enabler of change
45 Continued inequalities as a key societal challenge driving innovation in
welfare and education service sectors also in cross sector services of
education and health and welfare and education
Continued inequalities were identified as a key driving force for innovation within
both welfare and education sectors and in services which straddle the boundary
between education and health services and education and welfare services
Inequalities stem from issues of migration social originbackground
unemployment disability and gender and have been a source of the social
upheaval which has been seen in Europe in recent months
Within health education the link between socio-economic status and health is clear
with people from lower socio-economic groups experiencing poorer health and less
likely engaging in health promoting behaviours In the case of migrants health
messages need to be delivered in a culturally appropriate manner
46 Independent living as a key societal change driving innovation in the
welfare service sector
In terms of disability the emergence and spread of the independent living
philosophy has been a key change driving innovation in the welfare service sector
Typically innovation in this field involves new stakeholder roles with a much more
proactive role for service users in all stages of service provision design
implementation monitoring and fine tuning of services as well as a role in
coordination of different entitlementsservices andor administration and reporting
requirements The boundaries are being pushed further deeper and wider every
day Starting from persons with physical disabilities services are now promoting
active involvement of persons with severe mental disabilities a development that
was deemed impossible only 30 years ago
47 Social roles as a key societal change driving innovation for welfare and
for education service sectors
Changing social roles were identified as a key challenge driving innovation within
the welfare and education sectors These changes are within families and of the
family itself and include changing gender roles and changing family structures (eg
increase in single parent families increase in the numbers of older people living
alone) Families seem to be becoming a sphere of public or community interest
rather than an exclusively private one
Proper lsquosocializationrsquo of children is the key to building viable and sustainable
futures for individuals Early stage family intervention is necessary to prevent the
22
very emergence of conflicts lsquoExternalrsquo interventions often do not reach every day
interaction and thus the root causes of problems This is of significance for family
based projects as well as for care institutions and education providers
48 Organisational changes as a key societal change driving innovation in
welfare service sectors
The shifting of provision of services from the public sector into other sectors such
as independent profit making companies and social enterprises creates new
opportunities for innovation In addition there is an increasing move to provide
services locally in order to be more relevant and responsive and a move to
community based models of care
49 Changing management styles as a key innovation challenge for the
education service sector and in cross sector services of the health and
education sector
Connected to individualism as well as new social roles of individuals family
community and institutions management styles shaped by multi-stakeholder
involvement are gaining importance Community based models do not only increase
the complexity of players involved in the lsquovalue creationrsquo process but also the
enhancement of skill development and personality formation as well as the
fertilization of the educational landscape by innovative ideas expertise and
practices of diverse partners The latter fact also stimulates an increase in cross-
sectoral services (education health and social services) Simultaneously this
situation increases the necessity to spot choose and foster the lsquoinfluencesrsquo and
lsquocombinationsrsquo which realize the highest value through the assessment of social
impact
Increased emphasis is also being placed on illustrating and monitoring
performance Impact measurement and associated tools and practices gain
overarching importance
In terms of changing management styles within the health and education sector an
important aspect is the cooperation of different stakeholders and the involvement
of the community or userrsquos perspective Linked to increased user aspirations
people would like to take part in the development of programs and services With
their special knowledge of their condition for example they can contribute their
expertise within social services
23
5 Other key challenges driving innovation
Sociatal challenges and changes are of course only one driving force of innovation
In addition to these there are other meso and micro level factors which also drive
innovation These include research and development leading to new knowledge
professionally led innovation in response to users needs increasing costs of service
provision and demands for greater efficiency per se and specific political contexts
These other forces are included in the INNOSERV criteria framework in the
lsquochallengesrsquo box These factors are not a key focus for selection of projects for
INNOSERV as they are often very situation specific but will be noted in the case
studies where relevant The factors which prompt or trigger specific innovations
whether socially based or otherwise are not are not mutually exclusive (Bason
2010) and in there is a complex and interacting relationship between a variety of
factors for any given innovation lsquoinstancersquo In addition there are well documented
factors which act to inhibit the development of innovative responses (see Crepaldi
et al 201215)
This work package has sought to identify generic criteria and drivers but it must be
recognised that the dynamics of individual settings and local factors will impact on
the actual processes of adoption
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
24
6 Conclusions and next steps
This report has presented the framework which has been used within the INNOSERV
project to support the choice of innovative case studies and to assist in identifying
the innovation phenomena potential and processes important to future research in
this area The framework has been used to select projects as case studies (see Work
Package 4 report Eurich and Strifler 2012) The framework interlinks aspects of
innovation (novelty type context improvement sustainability) with analysis of
challenges and changes which are acting as driving forces of innovation in social
services As the project is future facing it is proposed that key social challenges
and changes are likely to inform the development of new change paradigms for the
delivery of social services across Europe The framework will inform further
development and testing of concepts through the next stages of the INNOSERVE
programme This process will result in descriptions for the key areas in which future
research on innovation in social services should be taken forward
25
7 Bibliography
Bason C (2010) Leading public sector innovation Co-creating for a better society
Bristol The Policy Press
Bereiter C (2002) Design research for sustained innovation Cognitive Studies
Bulletin of the Japanese Cognitive Society 9 321-327
Christensen CM and Overdorf M (2000) Meeting the Challenge of Disruptive
Change Harvard Business Review March-April
Clark M and Goodwin N (2010) Sustaining innovation in telehealth and telecare
WSDNA briefing paper London The Kings Fund
Crepaldi C De Rosa E And Pesce F (2012) Literature review on innovation in
social services in Europe (sectors of Health Education and Welfare
Services)INNOSERV Work Package 1 report
Department of Health (2011) Innovation Health and Wealth Accelerating Adoption
and Diffusion in the NHS London Department of Health
Eurich J and Strifler A (2012) European compared selection of innovative social
services INNOSERV Work Package 4 report
Fuglsang L (2010) Bricolage and invisible innovation in public service innovation
Journal of Innovation Economics 5 67-87
Greenhalgh T Robert G Macfarlane F Bate P Kyriakidou O (2004) Diffusion of
innovations in service organizations systematic review and recommendations
Milbank Quarterly 82581-629
Hartley J (2005) Innovation in Governance and Public Services Past and Present
Public Money and Management 25127-34
Koch P and Hauknes J (2005) On innovation in the Public Sector Publin report no
D20
Kuhn T (1962) The Structure of Scientific Revolutions Chicago The University of
Chicago Press
Lakatos I and Musgrave A (eds) (1970) Criticism and the growth of knowledge
London Cambridge University Press
May
C Finch T Mair F et al ( 2007) Understanding the implementation of
complex interventions in health care the normalization process model BMC Health
Services Research 2007 7148 doi1011861472-6963-7-148
May et al (2009) Implementing Embedding and Integrating Practices An Outline of
Normalization Process Theory Sociology 43 535-554
Murray R Caulier-Grice J and Mulgan G (2010) The Open Book of Social
Innovation London The Young Foundation
26
OECD (2005) Oslo manual Guidelines for collecting and interpreting innovation
data 3rd
edition
Oliver M (1990) The politics of disablement Basingstoke Macmillan Education Ltd
Osborne S (1998) Naming the Beast Defining and Classifying Service Innovations
in Social Policy Human Relations 51 9 1133-1154
Osborne S and Brown K (2005) Managing Change and Innovation in Public Service
Organizations London Routledge
Phills JA Deiglmeier K and Miller DT (2008) Rediscovering Social Innovation
Stamford Innovation Review 6 4 34-43
Sullivan M (1987) Sociology and Social Welfare London Allen and Unwin
Tidd J and Bessant J (2009) Managing Innovation Integrating Technological
Market and organizational Change 4th
edition Chichester John Wiley and Sons
UK Government Department of Health (2011) Innovation Health and Wealth
Accelerating adoption and diffusion in the NHS London Department of Health
Wolfensburger W (1975) The principle of normalisation in human services Toronto
National Institute on Mental Retardation
27
8 Appendices
Appendix 1 Summary of types and criteria of innovation used in Work Package
3 to identify practices
Identification of social service
Field(s) of service
Logic(s) of service
Self help or mutual aid logic Social care logic Multi-stakeholders logic Social
movements logic Combination
Activities of services delivered
Assistance for persons faced with personal challenges or crises (debt unemployment
drug addiction other) (Re)integration of persons into society (rehabilitation language
training for immigrants other) Services to the labour market (occupational training)
Social housing for disadvantaged groups Care (for the elderly children families )
Treatment and support of people with physical illnesses Treatment and support of
people with mental health problems Combination
Status of the provider organization
Public organization (governmental) Private organization ndash nonnot for profit Private
organization ndash profit Volunteer association Cooperative company or mutual company
Familyneighbourhood Civil society network Combination Other
Target group
Children Youngsters Elder people Unemployed people Poor people Immigrants
Disabled people People with chronic diseases ndash long-term health problems People with
acute or short term health problems No specific target group (eg territory-based social
services provision aiming at strengthen social ties) Combination Other
Size of the organization
Innovation
Type of innovation
New forms of organization resources hybridization new targeted actions new services
non-structural practices other
Innovative character
do the service practices appear to be something new in the field of social services
Origins of innovation
Supply side demand side broader operating factors
Impact on service performance
Effectiveness of service delivery
from user perspective cost effectivenesscapacity building sustainability of
innovation
Quality of provision
28
Socialization quality of life as judged by users and beneficiaries more inclusion
lower risk on exclusion participation of the user transition from institutional to
community based care
Potential wider effects
Promoting social and health equality sustainability new skills and jobs
increased social rights affordability of adequate and high quality health and long-
term care promotion of equality and non-discrimination equal access to adequate
provision
Transferability of innovations between national contexts
29
Appendix 2 levels of innovation identified within INNOSERV Work Package 2
literature review
Organizational level (policy organizational sectors)
New social services designed to face new needs or unmet needs
Search for new solutions to old needs new mechanisms or practices introduced in
preexisting
social services
to improve access to social services (ie more information increased
professionalism in
social work sector)
to guarantee entitlements (rights) for specific groups or minorities
to satisfy the demand for social services in a more complete and broad way
(holistic
approach)
to guarantee more participation and inclusion of citizens
New and increased Cross-Sectoral social services
Cross-Sectoral social services (ie teaching art to children while helping their mothers
for
job seeking and offering jobs for young artists)
Integrated care practices
Tearing down walls between sectors and the role of informal care
Sharing of knowledge
Better integration of Health and Social sector services
Territory based social services that contribute to the creation of training and job
opportunities for disadvantaged people
Solidarity-based social services
Social mediation for impaired and weakened people
Easy access to housing for poor families
New interfaces with clients
Logic(s) of service Self help or mutual aid logic Social care logic Multi-stakeholders
logic
Social movements logic
The development of the self-help sector
Actors New organizations (Cooperative society for social service provision ndashSCOP
Cooperative society as social enterprise with userrsquos involvement ndashSCIC)
New legal forms within structured public frameworks (Italy social cooperatives)
New provider organizations and existing organisations refashioned by new dynamics
New roles and relations among actors
New private organizations for profit and non-profit
Management style in the organization
Regulatory and legislative level
New architecture of the provision system
Socially responsible public contracts and social clauses (outsourcing)
Adherence to EU standards in transitional economies
Impact on institutional framework that shape innovation in social services
New arrangement between one or more government agencies andor external
organization
Organizational level ndash Connection and Cooperation (governance and partnership)
New networks and social movements established in order to design deliver and
finance
social services
Cooperation between sectors actors and different forms of provision
Cooperation between local actors
Increasing communication responsiveness
30
Utilizing connectivity and interdependencies
Modification of organizational systems (models of governance work organisation
number
of involved stakeholders in governance)
Public sector and local authorities as promoters of innovation and promoters of
crosssectoral
policy strategies
Third sector and user as promoters of innovation
Volunteer workers and initiatives launched by a group of citizens
Third sector and userrsquos engagement design (co-design and re-design services)
Joint decision process
Decision-making power not based on capital ownership
Employee and user driven innovation
Partnerships with users family carers and user organizations
Partnership between service users practitioners and academics
Community-based and participative health network in a local territory
Collaboration between public and volunteer organisations (NGOs) or between civil and
local
networks in collaboration with public organisations and social enterprises
New techniques for partnership building and functioning
Impact on social and power relations
Professional level (practitioners)
New practices in social work
Innovative tools (ie Theatre of the Oppressed) and the use of participated methods in
social
work (ie self-help group)
Networking
Individualised supports
New professional skills in social work
The use of informatics and new technologies in social work
Users
Participation and involvement of final users of services in designing delivering and
evaluating social services
Involvement of final users in promoting equality effectiveness and control and
adherence
to the needs of users
Conceptual Level (and value)
New models of society - Social goals participation user involvement community
benefit
New paradigms underlying a new social service concept or service delivery model (ie
new
inclusion paradigm active ageing)
Relationships and trust
Pursuing diversity
Better adjustment to usersrsquo needs more person centred support
More social services provision in less developed regions
New concept of accessibility of the service (ie for Roma families)
The concept of lsquoprogressive universalismrsquo
The Social Care Model
De-institutionalization and community care Improved home-based and community
services
Gender and diversity perspectives
Anti-discrimination and equality process
Increase of the level of recognition of social values objectives paradigms and goals
New models of interaction leading to social innovation processes
31
Public policy level (policy framework programs and social policies)
The new role of the system governance played by central (or local depending on
national
arrangements) government
Impact on public policies new public policy programme measure or intervention
Joint construction of a space for public action and redefinition of public governance
bodies
and methods
Innovative logics for public policies
Innovating the public sector
The new wide attention on anti stigma policies
E-government
Financial and economic sustainability level (and scaling-diffusion-transferability
of innovation)
New ways to overcome budgetary constraints
New approaches to acquire funding
The involvement of private investors
The introduction of special funds
The purchase of innovative practices by final users
Hybridization of resources (market redistribution and reciprocity resources)
New investment sources
Mobilising community resources taking full advantage of all endogenous resources
Improvement in efficiency and effectiveness
Financial and systemic sustainability Impact on the economy
Economic Environmental and Social Sustainability of Territory based social services
Financial tools necessary to territorial social initiatives and the way to unlock them
Capacity of spreading and diffusion
Evaluative level and attention for quality
Affordability availability and accessibility
New standards expected
New feedback loops from users and specialists
Social services of excellence as for quality efficiency and efficacy
New methods and creative tool-kits to strengthen and renew the quality of social care
services
Low-cost (for user) and high level quality of social services
Quality assurance moderation and accreditation mechanisms
New tools for monitoring social services - hearing all voices (users organizations
practioners staff family and friends)
Action research
Alternative economic and social indicators
Social impact and contribution of innovation in social services to social innovation and
social change ndash Assessment of innovation
Learning approach to evaluation ndash lsquoto learn from failuresrsquo
Developmental evaluation
Specifics for the Health sector
Disability from rehabilitation to integration and then to inclusion
Mental Health from segregation to inclusion and community care
HIV from segregationstigmatization to awareness campaigns for promoting self
protection
Innovation in the area of prevention of treatment and in the introduction of new
technologies
Emphasis on an inter-sectoral controlled and steered care in managed care models
replacement of the traditional insurance model
Integrated services
Technological progress
32
Specifics for the Education sector
Inclusive education
Inclusive education and training in collaboration with the civil society
Multicultural education
Integration of disciplines
Alternative schools non-regular schools and informal education
Link between formal and informal education
Community development based approaches
Connection between regular school and the system of social services
Experiential learning
Human rights education
Working lsquothrough relationshipsrsquo with children and young people
Problem based learning methodology
The lsquomedia educationrsquo The use of comics
ICT in schools
E-inclusion
Networks of schools
Improve supplement reinvent and transform learning
Sustained educational improvement
Learning Beyond the Classroom
Spreading a culture that values learning
More personalized approaches to learning
Using the web
Learning with and by not to and from
33
Appendix 3 analysis of social challenges and changes driving innovation
Welfare
Societal
change as
driving force
of innovation
in social
services
Meaning
description
Related
outcomesother
factors
Examples of innovative
responses
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
Empowerment self-
determination choice
The lsquoassertive userrsquo
Demand for more
individualised services of
better quality
Alternativecomplementary
providers
Personalisation
Co-production (new
userprofessional
relationships)
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demand on services
Potential for poor access
to services (from
communication
problems social
isolation)
Multiculturalism
Integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Declining female
caregiving
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
34
Increased demand for
services demand for
formal care
Continued
inequality
Continued
economic
inequality
unemployment
continued poverty
including child
poverty continued
institutionalisation
continued
inequality for
people with
disabilities ethnic
minorities gender
inequalities
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients
with complex
comorbidities increase
in certain diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing demand for
services Increasing
costsneed to make
limited resources go
further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
Decisions about value
marketization
Technological
development
Access to
information new
media technology
Facilitates self
determination increases
expectations and choice
population better
informed about
conditionsservicesright
s and less deferential
Users better able to
35
mobilise
Increased exclusion of
some groups with limited
access
New models of remote
care provision
Ability to exchange
information on quality
and experience
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Increasing costs
Decisions about value
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Organisational
change changing
management
styles
philosophies
Creating new
organisational
forms application
of more responsive
management
processes
performance
management
culture
Integration of
organisationsfunctions
new approaches to
lsquocommissioningrsquo of
organisationsservices
distortions caused by
lsquolocked inrsquo expenditures
(tertiary health care
residential care)
Decentralisation
deinstitutionalisation
marketization liberalisation
The lsquoenabling
statersquo Political
will fiscal space
Impact of financial
crisis competing
priorities for public
funds
Legacy of category-based
(not needs based) social
protection structural
transition
deindustrialisation
Health
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
EmpowermentSelf-
determination choice
Demand for more
individualised services of
better quality
Users better able to mobilise
Assertive lsquouserrsquo
knowledgeable patient
Alternativecomplimentary
providers
36
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demands on
services
Potential for poor access
to services (from
communication
problems social
isolation)
MulticulturalismTrained
health professionals
move to richer countries
integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Declining female
caregiving
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
Increased demand for
formal care services
Continued
inequalities
Unequal
distribution of
health risks and
health
outcomediseases
by socioeconomic
indicators
Unequal access to
care by social
status geography
gender and
ethnicity
Demographic Increase in
numbers of over
Increase in patients with
complex comorbidities
Increasing demand for care
Decisions about value Active
37
change 65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing costsneed to
make limited resources
go further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
ageing paradigm
Technological
development
Access to
information new
media technology
Self determination
expectations choice
population better
informed about
conditionsservicesright
s and less deferential
Ability to exchange
information on quality
and experience
New models of care provision
(eg telehealth care) new
health management systems
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Changing
management
stylesphilosophi
es
Application of
more responsive
management
processes
Decentralisation
deinstitutionalisation
marketization liberalisation
Lifestyle changes Increase in certain
diseases related to
obesity alcohol
and drug
Increasing
costsdemands for care
38
consumption and
stress diabetes
liver disease
anxiety and
depression
Education
Aspirations Rising expectations
by citizens for
better quality of
life
Self determination
choice consumerism
Education outside of formal
setting
Assertive user
Lifelong learningeducation
Migration Historical (post
colonial) migration
pan-EU migration
refugees
New needs for education
eg language and culture
Inequalities social
fragmentation
Social Roles Changing family
structure increase
in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
changing gender
roles rising
female
employment rates
Need to reconcile work
and family life
Parentingfamily skills
for vulnerable
parentsfamilies
Socialization of children
ndash social and emotional
deficits for children in
some environments
Work with families and
communities
Continued
inequalities
Inequality in
educational
accessattainment
by socioeconomic
status gender
people with
disabilities ethnic
minorities
Culture of failure
Promise to deliver social
mobility and economic
improvement
(Leadbeater and Wond
2010 pp 5-20)
Inclusive and multicultural
education
Differential support for
children from
lsquodisadvantagedrsquo
backgrounds
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients with
complex comorbidities
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
New group of older
39
learners
Technological
advance
Access to
information new
media technology
making learning
available in new
ways
Self determination
expectations choice
lsquoAssertive userrsquo
Increased exclusion of
some groups with limited
access
Changing
management
styles
philosophies
Community based models
Globalization Need to provide
educationtraining
which is suited to
modern knowledge
based global
economies
This report for the InnoServ project (grant agreement nr 290542) is supported
under the Socio-economic and Humanities Programme of FP7
Chris Hawker
Faculty of Health Sciences University of Southampton Building 67 University Road Highfield Campus Southampton SO17 1BJ
Tel +44 (0)23 8059 7968
Email CHawkersotonacuk
14
While for some writers a change must be radical or pattern breaking in order to be
innovation it has been argued that within services innovation can be small
adjustments (Fuglsang 2010) Fuglsang in fact argues for a view of innovation in
public sector services as a process of building of skills and expanding routines (68)
The second part of the argument lsquonew to whomrsquo is whether innovation relates to
absolute first use A common to view of innovation is not just those elements
developed within an institution but also those adopted from others (for example
see OECD (2005) for business sector innovation Phills et al (2008) regarding social
innovation Hartley (2005) and Koch (2005) in relation to innovation in public
services) Phills et al (2008) for example state
ldquoAlthough innovations need not necessarily be original they must be new to
the user context or applicationrdquo (Phills et al 37)
Osborne and Brown (2005) purport that most studies consider newness as new to a
person organisation society or situation but not necessarily first use (2005 120)
The authors go on to argue that these are in fact different forms of innovation
differently termed as objective and subjective innovation (Kimberly 1981) or
intrinsic and extrinsic innovation (Downs and Mohr 1976)
Hartley (2005) expounds the dissemination and adaptation of innovation to other
contexts as particularly important for public sector services arguing that public
goals ldquocan be enhanced through collaborative arrangements to create share
transfer adapt and embed good practicerdquo (27) She terms this ldquorsquolateralrsquo innovationrdquo
(33) of good practice adoption and adaption
An example of this approach to defining innovation within social services is seen in
the UK Government policy document on innovation within the National Health
Service which states
ldquoinnovation is as much about applying an idea service or product in a new
context or in a new organisation as it is about creating something newrdquo
(Department of Health 2011 9)
15
33 Hallmarks of innovation
Within social service systems it is not sufficient to focus only on novelty as a
marker of innovation In addition the INNOSERV framework includes certain
hallmarks of innovation including assessment of context quality and sustainability
331 Contextual fit
Different innovative approaches need to fit within different service framework
contexts and need adaptation to those contexts Drawing further on the above
discussion of novelty INNOSERV employ this to mean new to a given (for example
national) context This will reflect the diversity of social service contexts within the
European Union Case studies will also consider transferability of an innovation
from one context to another
332 Improvement in quality
ldquoIn public servicesinnovation is justifiable only where it increases public
value in the quality efficiency or fitness for purpose of governance or
servicesrdquo (Hartley 2005 30)
It is commonly understood that innovation is about improvement as well as novelty
Hartley (2005) offers a model which sets out the possible relationships between
innovation and improvement These relationships are for organisations showing no
improvement and no innovation improvement but no innovation innovation but no
improvement innovation and improvement Important points to highlight from this
model relate to innovation but no improvement first that innovations may not
always lead to success and a level of failure is to be expected second that
innovation can lead to increased but undesired choice loss of performance due to
the process of learning and innovations that are ultimately of no value In terms of
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
16
what is to be measured as improvement Hartley maintains that beyond
improvements in service quality and fitness for purpose wider issues of public
value should be considered
The difficulties of measurement and evaluation of innovation in social services need
to be highlighted as the measures of success within a social project are difficult to
define (Bason 2010 Murray et al 2010) Improvement of social services can
include improved quality of life and access to economic and social opportunity
These issues may relate differently in the fields of health welfare and education
For instance quality of life within health may relate to physical health and mental
wellbeing at different stages of life within welfare issues such as equality of access
to housing cultural and community activities and employment are important
The INNOSERV case studies will include available information on the outcomes of
the innovative project although these will likely vary in terms of types of
measurement used by the projects
333 Sustainability
ldquoInnovation is not just about the originating idea but also the whole process
of the successful development implementation and spread of that idea into
widespread userdquo (Department of Health 2011)
It is recognised that change through innovation needs to be sustainable (Bereiter
2002) Achieving a sustainable innovation may involve streamlining of ideas and
altering them to work in everyday practice (Murray et al 2010 12) The
Normalisation Process Model offered by May and colleagues (May et al 2007 May
et al 2009) provides a theoretical explanation within the context of health care of
the processes through which interventions become embedded in practice and then
integrated and sustained
17
4 Drivers of innovation key societal changes
Innovation within social services needs to be relevant to key social challenges and
changes This relates to the purpose of social services in responding to pressing
social demands and societal needs It is therefore important for the INNOSERV
project to have an understanding of the key social challenges and changes driving
innovation to inform the lsquotheoretical trendsrsquo influencing future innovation
requirements As part of this work package we have therefore sought to identify
social challenges and changes which may act as driving forces of innovation and
shape the development of social service lsquoparadigmsrsquo and hence future social
change
Using a lsquoscenario planningrsquo methodology borrowed from management science can
help to test the limits to any paradigm and identify where new paradigm models
may be needed in the future This in turn should help to identify where future
research interests could be located to explore not just opportunities for innovation
within the current paradigm but also where socially driven change is creating new
opportunities (or indeed requirements) for social and social services innovation
Further these challenges feed into social service provision in terms of an imperative
to address new needs and level of need and issues of rising costs
The INNOSERV project undertook such a scenario planning process the outcomes
of which inform what follows here Using an extended literature study on future
social challenges in the European context a number of key factors promoting a
response from and requiring change in social services were identified Individual
partners made further analysis of the important social challenges within their own
national context The factors were synthesised into a table of key social challenges
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
18
(see appendix 3) separately for health welfare and education sectors although
there was much overlap in the challenges relating to each sector
Small groups involving two country based teams in each case took each social
challenge and considered how it may change and develop given current
understandings of the forces affecting change (some forces may promote change
and some may block change) These were considered against potential political
developments economic developments socialsociological change technological
development legallegislative changes and environmental factors with a focus on
volume nature depth timeframe and scale of importance in influencing future
developments in social services
This work informed extensive discussion at the INNOSERV June 2012 Consortium
meeting with regard to the impact of key future developments on innovation and
the choice of projects which should be used to test key innovation developments
and their relevance to future service development
Relevance is represented in the INNOSERV criteria framework by the lsquodriversrsquo box
which includes a number of examples The most significant social challenges and
changes which were identified by the Consortium as most pertinent to innovation in
social services are listed in table 2 (page 19) and are explored further in the
remainder of this section The selection of projects as case studies has included
analysis of which of these social challenges and changes are being addressed (see
Work Package 4 report Eurich and Strifler 2012)
41 Demographic change as a key societal change driving innovation in the
health and welfare social service sectors
Demographic change was identified as a driving force of innovation in both health
and welfare services in Europe Current demographic change is resulting in
increased numbers of people living longer into old age with a particular increase in
the numbers of people aged over 80 This is alongside a reduction in the numbers
of people of working age in part due to a declining birth rate Further socio-cultural
change is leading to concerns about levels of informal care for older people
While many people will want to live active lives in old age some will live with long
periods of ill health and will have complex care needs resulting from multiple co-
morbidities Most however prefer to live as independently as possible
Questions arise about the ability to meet these increasing care demands from
declining tax income bases In addition the specific needs of elderly patients with
dementia represent a unique challenge for nursing staff and the organisation of
nursing services Financing of the rising health care costs for public agencies or for
health insurance schemes requires sustainable solutions and structural reforms
Traditional models of hospital lsquoacutersquo care may not necessarily be appropriate for
meeting these health care needs
This all highlights the need to find alternative solutions to care needs including the
use of technology and reliance on informal carers Current responses which are
relevant to this driver include integration of health and social care services to
increase cost efficiencies use of technological solutions to enhance self care and
care at home and new paradigms such as Active Ageing
19
Table 2 Key social challenges and changes driving innovation
Social
challengesocial
change driving
innovation
Meaning Social service sector
in which driver is key
Demographic
change
Increase in numbers of over 65s Greatest
increase in over 80 age group Increase in
old age dependency ratio
Health sector
Welfare sector
Aspirations Rising expectations of citizens for better
quality of lifebetter care
Health sector
Education sector
Cross sector services of
education and health
Lifestyles Increase in certain diseases related to
obesity alcohol and drug consumption
and stress diabetes liver disease anxiety
and depression
Health sector
Cross sector services of
education and health
Technology Access to information new media
technology
Health sector
Continued
inequalities
Continued economic inequality
unemployment continued poverty
including child poverty continued
institutionalisation continued inequality for
people with disabilities ethnic minorities
gender inequalities impact of socio-
economic status on health outcomes
Welfare sector
Education sector
Cross sector services of
education and health
and welfare and
education
Independent living The approach now adopted by disabled
people to live as ordinary members of
society and in their chosen domestic
setting
Welfare sector
Social roles Changing families increase in single
households increase in single parent
families changing generational relations
(due to longer life expectancy) reduction in
extended families
Changing gender roles rising female
employment rates
Welfare sector
Education sector
Organisational
changes
Creating new organisational forms
application of more responsive
management processes performance
management culture
Welfare sector
Changing
management
styles
Application of more responsive
management processes
Education sector
Cross sector services of
education and health
20
42 Aspirations as a key societal change driving innovation for health and
for education service sectors
Citizen aspirations were identified as a key societal change acting as a driving force
for innovation within both the health and education sectors and across the
boundary of these sectors Across Europe citizens are expecting a better quality of
life including improved outcomes from health and care services and reduced
inequalities
In terms of the health service sector this both derives from and manifests itself in
a population which is more informed about health issues Consequently patients
wish to be more involved in decisions about their health and their health care
options and are more willing and able to participate in the management of their
condition There is less deference to the medical profession and greater willingness
to make demands on health services There are a growing number of patient led
movements which are challenging some medical traditions
This aspect is fundamental both to everyday practice and to the future development
trajectory for health care services While most health aspirations are limited by
current knowledge and medical skill as research and medical advance offer new
choices and opportunities but at greater costs there will be difficult questions for
political debate This could well result in very different more personalised and
lsquopatient managedrsquo models of health care support
In terms of the education service sector individualism and the connected
aspiration of lsquobeing involvedrsquo has been an increasing trend over the past years and
is expected to keep gaining importance This is not only reflected by agendas of
individually shaped curricula or learning arrangements in school but also by the
opening of the public (ie government funded) school system towards involvement
of the community (seniors in school corporate sponsoring external initiatives of
informal learning and personality formation etc) This is reflected in a similar way
in higher education (eg service learning) and adult education (lsquolearning regionsrsquo)
Across the boundary of health and education aspirations coupled with medical
advance lead to a desire for independence of disabled people and those with long
term conditions This highlights the need for health programs focussed on self
esteem
43 Lifestyles as a key societal challenge driving innovation in the health
service sector and also in the cross sector services of health and education
A key social challenge acting as a driving force for innovation for the health sector
and in the cross sector services of education and health is a recognised growth in
lsquolifestylersquo related conditions arising from unhealthy behaviours such as poor diet
alcohol consumption and smoking (although there is limited evidence of a decline
in smoking rates as its harmful effects are less well tolerated) Political investment
in public health is recognised as an important strategic ambition but often not
matched by financial resources Questions about personal responsibility are also
being asked with suggestions that people with poor health behaviours should not
be given the same priority to responsive health care services As other factors
impacting on health outcomes become more responsive to medical advance these
factors are growing in importance in their impact both on wider society and in
improving overall health outcomes
21
44 Technology as a key societal change driving innovation in the health
service sector
The growth in internet and web based technology is leading to an exponential
growth in access to information and new forms of communication More people
now use the internet as their primary health care information resource Web
lsquocommunitiesrsquo are linking and thus empowering people faced with similar health
challenges Telehealthcare solutions to on-going care needs are becoming more
widely available and are changing the patterns of demands for some health care
services Other new technologies for example in transport and in home assistance
devices are enabling greater independence for disabled people
As future generations use and expect more from access to information and
communication services health care services will have to respond to both the
demands and the opportunities created by such technology Technology can be
seen as both a driving force for innovation and as an enabler of change
45 Continued inequalities as a key societal challenge driving innovation in
welfare and education service sectors also in cross sector services of
education and health and welfare and education
Continued inequalities were identified as a key driving force for innovation within
both welfare and education sectors and in services which straddle the boundary
between education and health services and education and welfare services
Inequalities stem from issues of migration social originbackground
unemployment disability and gender and have been a source of the social
upheaval which has been seen in Europe in recent months
Within health education the link between socio-economic status and health is clear
with people from lower socio-economic groups experiencing poorer health and less
likely engaging in health promoting behaviours In the case of migrants health
messages need to be delivered in a culturally appropriate manner
46 Independent living as a key societal change driving innovation in the
welfare service sector
In terms of disability the emergence and spread of the independent living
philosophy has been a key change driving innovation in the welfare service sector
Typically innovation in this field involves new stakeholder roles with a much more
proactive role for service users in all stages of service provision design
implementation monitoring and fine tuning of services as well as a role in
coordination of different entitlementsservices andor administration and reporting
requirements The boundaries are being pushed further deeper and wider every
day Starting from persons with physical disabilities services are now promoting
active involvement of persons with severe mental disabilities a development that
was deemed impossible only 30 years ago
47 Social roles as a key societal change driving innovation for welfare and
for education service sectors
Changing social roles were identified as a key challenge driving innovation within
the welfare and education sectors These changes are within families and of the
family itself and include changing gender roles and changing family structures (eg
increase in single parent families increase in the numbers of older people living
alone) Families seem to be becoming a sphere of public or community interest
rather than an exclusively private one
Proper lsquosocializationrsquo of children is the key to building viable and sustainable
futures for individuals Early stage family intervention is necessary to prevent the
22
very emergence of conflicts lsquoExternalrsquo interventions often do not reach every day
interaction and thus the root causes of problems This is of significance for family
based projects as well as for care institutions and education providers
48 Organisational changes as a key societal change driving innovation in
welfare service sectors
The shifting of provision of services from the public sector into other sectors such
as independent profit making companies and social enterprises creates new
opportunities for innovation In addition there is an increasing move to provide
services locally in order to be more relevant and responsive and a move to
community based models of care
49 Changing management styles as a key innovation challenge for the
education service sector and in cross sector services of the health and
education sector
Connected to individualism as well as new social roles of individuals family
community and institutions management styles shaped by multi-stakeholder
involvement are gaining importance Community based models do not only increase
the complexity of players involved in the lsquovalue creationrsquo process but also the
enhancement of skill development and personality formation as well as the
fertilization of the educational landscape by innovative ideas expertise and
practices of diverse partners The latter fact also stimulates an increase in cross-
sectoral services (education health and social services) Simultaneously this
situation increases the necessity to spot choose and foster the lsquoinfluencesrsquo and
lsquocombinationsrsquo which realize the highest value through the assessment of social
impact
Increased emphasis is also being placed on illustrating and monitoring
performance Impact measurement and associated tools and practices gain
overarching importance
In terms of changing management styles within the health and education sector an
important aspect is the cooperation of different stakeholders and the involvement
of the community or userrsquos perspective Linked to increased user aspirations
people would like to take part in the development of programs and services With
their special knowledge of their condition for example they can contribute their
expertise within social services
23
5 Other key challenges driving innovation
Sociatal challenges and changes are of course only one driving force of innovation
In addition to these there are other meso and micro level factors which also drive
innovation These include research and development leading to new knowledge
professionally led innovation in response to users needs increasing costs of service
provision and demands for greater efficiency per se and specific political contexts
These other forces are included in the INNOSERV criteria framework in the
lsquochallengesrsquo box These factors are not a key focus for selection of projects for
INNOSERV as they are often very situation specific but will be noted in the case
studies where relevant The factors which prompt or trigger specific innovations
whether socially based or otherwise are not are not mutually exclusive (Bason
2010) and in there is a complex and interacting relationship between a variety of
factors for any given innovation lsquoinstancersquo In addition there are well documented
factors which act to inhibit the development of innovative responses (see Crepaldi
et al 201215)
This work package has sought to identify generic criteria and drivers but it must be
recognised that the dynamics of individual settings and local factors will impact on
the actual processes of adoption
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
24
6 Conclusions and next steps
This report has presented the framework which has been used within the INNOSERV
project to support the choice of innovative case studies and to assist in identifying
the innovation phenomena potential and processes important to future research in
this area The framework has been used to select projects as case studies (see Work
Package 4 report Eurich and Strifler 2012) The framework interlinks aspects of
innovation (novelty type context improvement sustainability) with analysis of
challenges and changes which are acting as driving forces of innovation in social
services As the project is future facing it is proposed that key social challenges
and changes are likely to inform the development of new change paradigms for the
delivery of social services across Europe The framework will inform further
development and testing of concepts through the next stages of the INNOSERVE
programme This process will result in descriptions for the key areas in which future
research on innovation in social services should be taken forward
25
7 Bibliography
Bason C (2010) Leading public sector innovation Co-creating for a better society
Bristol The Policy Press
Bereiter C (2002) Design research for sustained innovation Cognitive Studies
Bulletin of the Japanese Cognitive Society 9 321-327
Christensen CM and Overdorf M (2000) Meeting the Challenge of Disruptive
Change Harvard Business Review March-April
Clark M and Goodwin N (2010) Sustaining innovation in telehealth and telecare
WSDNA briefing paper London The Kings Fund
Crepaldi C De Rosa E And Pesce F (2012) Literature review on innovation in
social services in Europe (sectors of Health Education and Welfare
Services)INNOSERV Work Package 1 report
Department of Health (2011) Innovation Health and Wealth Accelerating Adoption
and Diffusion in the NHS London Department of Health
Eurich J and Strifler A (2012) European compared selection of innovative social
services INNOSERV Work Package 4 report
Fuglsang L (2010) Bricolage and invisible innovation in public service innovation
Journal of Innovation Economics 5 67-87
Greenhalgh T Robert G Macfarlane F Bate P Kyriakidou O (2004) Diffusion of
innovations in service organizations systematic review and recommendations
Milbank Quarterly 82581-629
Hartley J (2005) Innovation in Governance and Public Services Past and Present
Public Money and Management 25127-34
Koch P and Hauknes J (2005) On innovation in the Public Sector Publin report no
D20
Kuhn T (1962) The Structure of Scientific Revolutions Chicago The University of
Chicago Press
Lakatos I and Musgrave A (eds) (1970) Criticism and the growth of knowledge
London Cambridge University Press
May
C Finch T Mair F et al ( 2007) Understanding the implementation of
complex interventions in health care the normalization process model BMC Health
Services Research 2007 7148 doi1011861472-6963-7-148
May et al (2009) Implementing Embedding and Integrating Practices An Outline of
Normalization Process Theory Sociology 43 535-554
Murray R Caulier-Grice J and Mulgan G (2010) The Open Book of Social
Innovation London The Young Foundation
26
OECD (2005) Oslo manual Guidelines for collecting and interpreting innovation
data 3rd
edition
Oliver M (1990) The politics of disablement Basingstoke Macmillan Education Ltd
Osborne S (1998) Naming the Beast Defining and Classifying Service Innovations
in Social Policy Human Relations 51 9 1133-1154
Osborne S and Brown K (2005) Managing Change and Innovation in Public Service
Organizations London Routledge
Phills JA Deiglmeier K and Miller DT (2008) Rediscovering Social Innovation
Stamford Innovation Review 6 4 34-43
Sullivan M (1987) Sociology and Social Welfare London Allen and Unwin
Tidd J and Bessant J (2009) Managing Innovation Integrating Technological
Market and organizational Change 4th
edition Chichester John Wiley and Sons
UK Government Department of Health (2011) Innovation Health and Wealth
Accelerating adoption and diffusion in the NHS London Department of Health
Wolfensburger W (1975) The principle of normalisation in human services Toronto
National Institute on Mental Retardation
27
8 Appendices
Appendix 1 Summary of types and criteria of innovation used in Work Package
3 to identify practices
Identification of social service
Field(s) of service
Logic(s) of service
Self help or mutual aid logic Social care logic Multi-stakeholders logic Social
movements logic Combination
Activities of services delivered
Assistance for persons faced with personal challenges or crises (debt unemployment
drug addiction other) (Re)integration of persons into society (rehabilitation language
training for immigrants other) Services to the labour market (occupational training)
Social housing for disadvantaged groups Care (for the elderly children families )
Treatment and support of people with physical illnesses Treatment and support of
people with mental health problems Combination
Status of the provider organization
Public organization (governmental) Private organization ndash nonnot for profit Private
organization ndash profit Volunteer association Cooperative company or mutual company
Familyneighbourhood Civil society network Combination Other
Target group
Children Youngsters Elder people Unemployed people Poor people Immigrants
Disabled people People with chronic diseases ndash long-term health problems People with
acute or short term health problems No specific target group (eg territory-based social
services provision aiming at strengthen social ties) Combination Other
Size of the organization
Innovation
Type of innovation
New forms of organization resources hybridization new targeted actions new services
non-structural practices other
Innovative character
do the service practices appear to be something new in the field of social services
Origins of innovation
Supply side demand side broader operating factors
Impact on service performance
Effectiveness of service delivery
from user perspective cost effectivenesscapacity building sustainability of
innovation
Quality of provision
28
Socialization quality of life as judged by users and beneficiaries more inclusion
lower risk on exclusion participation of the user transition from institutional to
community based care
Potential wider effects
Promoting social and health equality sustainability new skills and jobs
increased social rights affordability of adequate and high quality health and long-
term care promotion of equality and non-discrimination equal access to adequate
provision
Transferability of innovations between national contexts
29
Appendix 2 levels of innovation identified within INNOSERV Work Package 2
literature review
Organizational level (policy organizational sectors)
New social services designed to face new needs or unmet needs
Search for new solutions to old needs new mechanisms or practices introduced in
preexisting
social services
to improve access to social services (ie more information increased
professionalism in
social work sector)
to guarantee entitlements (rights) for specific groups or minorities
to satisfy the demand for social services in a more complete and broad way
(holistic
approach)
to guarantee more participation and inclusion of citizens
New and increased Cross-Sectoral social services
Cross-Sectoral social services (ie teaching art to children while helping their mothers
for
job seeking and offering jobs for young artists)
Integrated care practices
Tearing down walls between sectors and the role of informal care
Sharing of knowledge
Better integration of Health and Social sector services
Territory based social services that contribute to the creation of training and job
opportunities for disadvantaged people
Solidarity-based social services
Social mediation for impaired and weakened people
Easy access to housing for poor families
New interfaces with clients
Logic(s) of service Self help or mutual aid logic Social care logic Multi-stakeholders
logic
Social movements logic
The development of the self-help sector
Actors New organizations (Cooperative society for social service provision ndashSCOP
Cooperative society as social enterprise with userrsquos involvement ndashSCIC)
New legal forms within structured public frameworks (Italy social cooperatives)
New provider organizations and existing organisations refashioned by new dynamics
New roles and relations among actors
New private organizations for profit and non-profit
Management style in the organization
Regulatory and legislative level
New architecture of the provision system
Socially responsible public contracts and social clauses (outsourcing)
Adherence to EU standards in transitional economies
Impact on institutional framework that shape innovation in social services
New arrangement between one or more government agencies andor external
organization
Organizational level ndash Connection and Cooperation (governance and partnership)
New networks and social movements established in order to design deliver and
finance
social services
Cooperation between sectors actors and different forms of provision
Cooperation between local actors
Increasing communication responsiveness
30
Utilizing connectivity and interdependencies
Modification of organizational systems (models of governance work organisation
number
of involved stakeholders in governance)
Public sector and local authorities as promoters of innovation and promoters of
crosssectoral
policy strategies
Third sector and user as promoters of innovation
Volunteer workers and initiatives launched by a group of citizens
Third sector and userrsquos engagement design (co-design and re-design services)
Joint decision process
Decision-making power not based on capital ownership
Employee and user driven innovation
Partnerships with users family carers and user organizations
Partnership between service users practitioners and academics
Community-based and participative health network in a local territory
Collaboration between public and volunteer organisations (NGOs) or between civil and
local
networks in collaboration with public organisations and social enterprises
New techniques for partnership building and functioning
Impact on social and power relations
Professional level (practitioners)
New practices in social work
Innovative tools (ie Theatre of the Oppressed) and the use of participated methods in
social
work (ie self-help group)
Networking
Individualised supports
New professional skills in social work
The use of informatics and new technologies in social work
Users
Participation and involvement of final users of services in designing delivering and
evaluating social services
Involvement of final users in promoting equality effectiveness and control and
adherence
to the needs of users
Conceptual Level (and value)
New models of society - Social goals participation user involvement community
benefit
New paradigms underlying a new social service concept or service delivery model (ie
new
inclusion paradigm active ageing)
Relationships and trust
Pursuing diversity
Better adjustment to usersrsquo needs more person centred support
More social services provision in less developed regions
New concept of accessibility of the service (ie for Roma families)
The concept of lsquoprogressive universalismrsquo
The Social Care Model
De-institutionalization and community care Improved home-based and community
services
Gender and diversity perspectives
Anti-discrimination and equality process
Increase of the level of recognition of social values objectives paradigms and goals
New models of interaction leading to social innovation processes
31
Public policy level (policy framework programs and social policies)
The new role of the system governance played by central (or local depending on
national
arrangements) government
Impact on public policies new public policy programme measure or intervention
Joint construction of a space for public action and redefinition of public governance
bodies
and methods
Innovative logics for public policies
Innovating the public sector
The new wide attention on anti stigma policies
E-government
Financial and economic sustainability level (and scaling-diffusion-transferability
of innovation)
New ways to overcome budgetary constraints
New approaches to acquire funding
The involvement of private investors
The introduction of special funds
The purchase of innovative practices by final users
Hybridization of resources (market redistribution and reciprocity resources)
New investment sources
Mobilising community resources taking full advantage of all endogenous resources
Improvement in efficiency and effectiveness
Financial and systemic sustainability Impact on the economy
Economic Environmental and Social Sustainability of Territory based social services
Financial tools necessary to territorial social initiatives and the way to unlock them
Capacity of spreading and diffusion
Evaluative level and attention for quality
Affordability availability and accessibility
New standards expected
New feedback loops from users and specialists
Social services of excellence as for quality efficiency and efficacy
New methods and creative tool-kits to strengthen and renew the quality of social care
services
Low-cost (for user) and high level quality of social services
Quality assurance moderation and accreditation mechanisms
New tools for monitoring social services - hearing all voices (users organizations
practioners staff family and friends)
Action research
Alternative economic and social indicators
Social impact and contribution of innovation in social services to social innovation and
social change ndash Assessment of innovation
Learning approach to evaluation ndash lsquoto learn from failuresrsquo
Developmental evaluation
Specifics for the Health sector
Disability from rehabilitation to integration and then to inclusion
Mental Health from segregation to inclusion and community care
HIV from segregationstigmatization to awareness campaigns for promoting self
protection
Innovation in the area of prevention of treatment and in the introduction of new
technologies
Emphasis on an inter-sectoral controlled and steered care in managed care models
replacement of the traditional insurance model
Integrated services
Technological progress
32
Specifics for the Education sector
Inclusive education
Inclusive education and training in collaboration with the civil society
Multicultural education
Integration of disciplines
Alternative schools non-regular schools and informal education
Link between formal and informal education
Community development based approaches
Connection between regular school and the system of social services
Experiential learning
Human rights education
Working lsquothrough relationshipsrsquo with children and young people
Problem based learning methodology
The lsquomedia educationrsquo The use of comics
ICT in schools
E-inclusion
Networks of schools
Improve supplement reinvent and transform learning
Sustained educational improvement
Learning Beyond the Classroom
Spreading a culture that values learning
More personalized approaches to learning
Using the web
Learning with and by not to and from
33
Appendix 3 analysis of social challenges and changes driving innovation
Welfare
Societal
change as
driving force
of innovation
in social
services
Meaning
description
Related
outcomesother
factors
Examples of innovative
responses
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
Empowerment self-
determination choice
The lsquoassertive userrsquo
Demand for more
individualised services of
better quality
Alternativecomplementary
providers
Personalisation
Co-production (new
userprofessional
relationships)
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demand on services
Potential for poor access
to services (from
communication
problems social
isolation)
Multiculturalism
Integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Declining female
caregiving
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
34
Increased demand for
services demand for
formal care
Continued
inequality
Continued
economic
inequality
unemployment
continued poverty
including child
poverty continued
institutionalisation
continued
inequality for
people with
disabilities ethnic
minorities gender
inequalities
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients
with complex
comorbidities increase
in certain diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing demand for
services Increasing
costsneed to make
limited resources go
further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
Decisions about value
marketization
Technological
development
Access to
information new
media technology
Facilitates self
determination increases
expectations and choice
population better
informed about
conditionsservicesright
s and less deferential
Users better able to
35
mobilise
Increased exclusion of
some groups with limited
access
New models of remote
care provision
Ability to exchange
information on quality
and experience
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Increasing costs
Decisions about value
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Organisational
change changing
management
styles
philosophies
Creating new
organisational
forms application
of more responsive
management
processes
performance
management
culture
Integration of
organisationsfunctions
new approaches to
lsquocommissioningrsquo of
organisationsservices
distortions caused by
lsquolocked inrsquo expenditures
(tertiary health care
residential care)
Decentralisation
deinstitutionalisation
marketization liberalisation
The lsquoenabling
statersquo Political
will fiscal space
Impact of financial
crisis competing
priorities for public
funds
Legacy of category-based
(not needs based) social
protection structural
transition
deindustrialisation
Health
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
EmpowermentSelf-
determination choice
Demand for more
individualised services of
better quality
Users better able to mobilise
Assertive lsquouserrsquo
knowledgeable patient
Alternativecomplimentary
providers
36
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demands on
services
Potential for poor access
to services (from
communication
problems social
isolation)
MulticulturalismTrained
health professionals
move to richer countries
integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Declining female
caregiving
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
Increased demand for
formal care services
Continued
inequalities
Unequal
distribution of
health risks and
health
outcomediseases
by socioeconomic
indicators
Unequal access to
care by social
status geography
gender and
ethnicity
Demographic Increase in
numbers of over
Increase in patients with
complex comorbidities
Increasing demand for care
Decisions about value Active
37
change 65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing costsneed to
make limited resources
go further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
ageing paradigm
Technological
development
Access to
information new
media technology
Self determination
expectations choice
population better
informed about
conditionsservicesright
s and less deferential
Ability to exchange
information on quality
and experience
New models of care provision
(eg telehealth care) new
health management systems
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Changing
management
stylesphilosophi
es
Application of
more responsive
management
processes
Decentralisation
deinstitutionalisation
marketization liberalisation
Lifestyle changes Increase in certain
diseases related to
obesity alcohol
and drug
Increasing
costsdemands for care
38
consumption and
stress diabetes
liver disease
anxiety and
depression
Education
Aspirations Rising expectations
by citizens for
better quality of
life
Self determination
choice consumerism
Education outside of formal
setting
Assertive user
Lifelong learningeducation
Migration Historical (post
colonial) migration
pan-EU migration
refugees
New needs for education
eg language and culture
Inequalities social
fragmentation
Social Roles Changing family
structure increase
in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
changing gender
roles rising
female
employment rates
Need to reconcile work
and family life
Parentingfamily skills
for vulnerable
parentsfamilies
Socialization of children
ndash social and emotional
deficits for children in
some environments
Work with families and
communities
Continued
inequalities
Inequality in
educational
accessattainment
by socioeconomic
status gender
people with
disabilities ethnic
minorities
Culture of failure
Promise to deliver social
mobility and economic
improvement
(Leadbeater and Wond
2010 pp 5-20)
Inclusive and multicultural
education
Differential support for
children from
lsquodisadvantagedrsquo
backgrounds
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients with
complex comorbidities
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
New group of older
39
learners
Technological
advance
Access to
information new
media technology
making learning
available in new
ways
Self determination
expectations choice
lsquoAssertive userrsquo
Increased exclusion of
some groups with limited
access
Changing
management
styles
philosophies
Community based models
Globalization Need to provide
educationtraining
which is suited to
modern knowledge
based global
economies
This report for the InnoServ project (grant agreement nr 290542) is supported
under the Socio-economic and Humanities Programme of FP7
Chris Hawker
Faculty of Health Sciences University of Southampton Building 67 University Road Highfield Campus Southampton SO17 1BJ
Tel +44 (0)23 8059 7968
Email CHawkersotonacuk
15
33 Hallmarks of innovation
Within social service systems it is not sufficient to focus only on novelty as a
marker of innovation In addition the INNOSERV framework includes certain
hallmarks of innovation including assessment of context quality and sustainability
331 Contextual fit
Different innovative approaches need to fit within different service framework
contexts and need adaptation to those contexts Drawing further on the above
discussion of novelty INNOSERV employ this to mean new to a given (for example
national) context This will reflect the diversity of social service contexts within the
European Union Case studies will also consider transferability of an innovation
from one context to another
332 Improvement in quality
ldquoIn public servicesinnovation is justifiable only where it increases public
value in the quality efficiency or fitness for purpose of governance or
servicesrdquo (Hartley 2005 30)
It is commonly understood that innovation is about improvement as well as novelty
Hartley (2005) offers a model which sets out the possible relationships between
innovation and improvement These relationships are for organisations showing no
improvement and no innovation improvement but no innovation innovation but no
improvement innovation and improvement Important points to highlight from this
model relate to innovation but no improvement first that innovations may not
always lead to success and a level of failure is to be expected second that
innovation can lead to increased but undesired choice loss of performance due to
the process of learning and innovations that are ultimately of no value In terms of
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
16
what is to be measured as improvement Hartley maintains that beyond
improvements in service quality and fitness for purpose wider issues of public
value should be considered
The difficulties of measurement and evaluation of innovation in social services need
to be highlighted as the measures of success within a social project are difficult to
define (Bason 2010 Murray et al 2010) Improvement of social services can
include improved quality of life and access to economic and social opportunity
These issues may relate differently in the fields of health welfare and education
For instance quality of life within health may relate to physical health and mental
wellbeing at different stages of life within welfare issues such as equality of access
to housing cultural and community activities and employment are important
The INNOSERV case studies will include available information on the outcomes of
the innovative project although these will likely vary in terms of types of
measurement used by the projects
333 Sustainability
ldquoInnovation is not just about the originating idea but also the whole process
of the successful development implementation and spread of that idea into
widespread userdquo (Department of Health 2011)
It is recognised that change through innovation needs to be sustainable (Bereiter
2002) Achieving a sustainable innovation may involve streamlining of ideas and
altering them to work in everyday practice (Murray et al 2010 12) The
Normalisation Process Model offered by May and colleagues (May et al 2007 May
et al 2009) provides a theoretical explanation within the context of health care of
the processes through which interventions become embedded in practice and then
integrated and sustained
17
4 Drivers of innovation key societal changes
Innovation within social services needs to be relevant to key social challenges and
changes This relates to the purpose of social services in responding to pressing
social demands and societal needs It is therefore important for the INNOSERV
project to have an understanding of the key social challenges and changes driving
innovation to inform the lsquotheoretical trendsrsquo influencing future innovation
requirements As part of this work package we have therefore sought to identify
social challenges and changes which may act as driving forces of innovation and
shape the development of social service lsquoparadigmsrsquo and hence future social
change
Using a lsquoscenario planningrsquo methodology borrowed from management science can
help to test the limits to any paradigm and identify where new paradigm models
may be needed in the future This in turn should help to identify where future
research interests could be located to explore not just opportunities for innovation
within the current paradigm but also where socially driven change is creating new
opportunities (or indeed requirements) for social and social services innovation
Further these challenges feed into social service provision in terms of an imperative
to address new needs and level of need and issues of rising costs
The INNOSERV project undertook such a scenario planning process the outcomes
of which inform what follows here Using an extended literature study on future
social challenges in the European context a number of key factors promoting a
response from and requiring change in social services were identified Individual
partners made further analysis of the important social challenges within their own
national context The factors were synthesised into a table of key social challenges
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
18
(see appendix 3) separately for health welfare and education sectors although
there was much overlap in the challenges relating to each sector
Small groups involving two country based teams in each case took each social
challenge and considered how it may change and develop given current
understandings of the forces affecting change (some forces may promote change
and some may block change) These were considered against potential political
developments economic developments socialsociological change technological
development legallegislative changes and environmental factors with a focus on
volume nature depth timeframe and scale of importance in influencing future
developments in social services
This work informed extensive discussion at the INNOSERV June 2012 Consortium
meeting with regard to the impact of key future developments on innovation and
the choice of projects which should be used to test key innovation developments
and their relevance to future service development
Relevance is represented in the INNOSERV criteria framework by the lsquodriversrsquo box
which includes a number of examples The most significant social challenges and
changes which were identified by the Consortium as most pertinent to innovation in
social services are listed in table 2 (page 19) and are explored further in the
remainder of this section The selection of projects as case studies has included
analysis of which of these social challenges and changes are being addressed (see
Work Package 4 report Eurich and Strifler 2012)
41 Demographic change as a key societal change driving innovation in the
health and welfare social service sectors
Demographic change was identified as a driving force of innovation in both health
and welfare services in Europe Current demographic change is resulting in
increased numbers of people living longer into old age with a particular increase in
the numbers of people aged over 80 This is alongside a reduction in the numbers
of people of working age in part due to a declining birth rate Further socio-cultural
change is leading to concerns about levels of informal care for older people
While many people will want to live active lives in old age some will live with long
periods of ill health and will have complex care needs resulting from multiple co-
morbidities Most however prefer to live as independently as possible
Questions arise about the ability to meet these increasing care demands from
declining tax income bases In addition the specific needs of elderly patients with
dementia represent a unique challenge for nursing staff and the organisation of
nursing services Financing of the rising health care costs for public agencies or for
health insurance schemes requires sustainable solutions and structural reforms
Traditional models of hospital lsquoacutersquo care may not necessarily be appropriate for
meeting these health care needs
This all highlights the need to find alternative solutions to care needs including the
use of technology and reliance on informal carers Current responses which are
relevant to this driver include integration of health and social care services to
increase cost efficiencies use of technological solutions to enhance self care and
care at home and new paradigms such as Active Ageing
19
Table 2 Key social challenges and changes driving innovation
Social
challengesocial
change driving
innovation
Meaning Social service sector
in which driver is key
Demographic
change
Increase in numbers of over 65s Greatest
increase in over 80 age group Increase in
old age dependency ratio
Health sector
Welfare sector
Aspirations Rising expectations of citizens for better
quality of lifebetter care
Health sector
Education sector
Cross sector services of
education and health
Lifestyles Increase in certain diseases related to
obesity alcohol and drug consumption
and stress diabetes liver disease anxiety
and depression
Health sector
Cross sector services of
education and health
Technology Access to information new media
technology
Health sector
Continued
inequalities
Continued economic inequality
unemployment continued poverty
including child poverty continued
institutionalisation continued inequality for
people with disabilities ethnic minorities
gender inequalities impact of socio-
economic status on health outcomes
Welfare sector
Education sector
Cross sector services of
education and health
and welfare and
education
Independent living The approach now adopted by disabled
people to live as ordinary members of
society and in their chosen domestic
setting
Welfare sector
Social roles Changing families increase in single
households increase in single parent
families changing generational relations
(due to longer life expectancy) reduction in
extended families
Changing gender roles rising female
employment rates
Welfare sector
Education sector
Organisational
changes
Creating new organisational forms
application of more responsive
management processes performance
management culture
Welfare sector
Changing
management
styles
Application of more responsive
management processes
Education sector
Cross sector services of
education and health
20
42 Aspirations as a key societal change driving innovation for health and
for education service sectors
Citizen aspirations were identified as a key societal change acting as a driving force
for innovation within both the health and education sectors and across the
boundary of these sectors Across Europe citizens are expecting a better quality of
life including improved outcomes from health and care services and reduced
inequalities
In terms of the health service sector this both derives from and manifests itself in
a population which is more informed about health issues Consequently patients
wish to be more involved in decisions about their health and their health care
options and are more willing and able to participate in the management of their
condition There is less deference to the medical profession and greater willingness
to make demands on health services There are a growing number of patient led
movements which are challenging some medical traditions
This aspect is fundamental both to everyday practice and to the future development
trajectory for health care services While most health aspirations are limited by
current knowledge and medical skill as research and medical advance offer new
choices and opportunities but at greater costs there will be difficult questions for
political debate This could well result in very different more personalised and
lsquopatient managedrsquo models of health care support
In terms of the education service sector individualism and the connected
aspiration of lsquobeing involvedrsquo has been an increasing trend over the past years and
is expected to keep gaining importance This is not only reflected by agendas of
individually shaped curricula or learning arrangements in school but also by the
opening of the public (ie government funded) school system towards involvement
of the community (seniors in school corporate sponsoring external initiatives of
informal learning and personality formation etc) This is reflected in a similar way
in higher education (eg service learning) and adult education (lsquolearning regionsrsquo)
Across the boundary of health and education aspirations coupled with medical
advance lead to a desire for independence of disabled people and those with long
term conditions This highlights the need for health programs focussed on self
esteem
43 Lifestyles as a key societal challenge driving innovation in the health
service sector and also in the cross sector services of health and education
A key social challenge acting as a driving force for innovation for the health sector
and in the cross sector services of education and health is a recognised growth in
lsquolifestylersquo related conditions arising from unhealthy behaviours such as poor diet
alcohol consumption and smoking (although there is limited evidence of a decline
in smoking rates as its harmful effects are less well tolerated) Political investment
in public health is recognised as an important strategic ambition but often not
matched by financial resources Questions about personal responsibility are also
being asked with suggestions that people with poor health behaviours should not
be given the same priority to responsive health care services As other factors
impacting on health outcomes become more responsive to medical advance these
factors are growing in importance in their impact both on wider society and in
improving overall health outcomes
21
44 Technology as a key societal change driving innovation in the health
service sector
The growth in internet and web based technology is leading to an exponential
growth in access to information and new forms of communication More people
now use the internet as their primary health care information resource Web
lsquocommunitiesrsquo are linking and thus empowering people faced with similar health
challenges Telehealthcare solutions to on-going care needs are becoming more
widely available and are changing the patterns of demands for some health care
services Other new technologies for example in transport and in home assistance
devices are enabling greater independence for disabled people
As future generations use and expect more from access to information and
communication services health care services will have to respond to both the
demands and the opportunities created by such technology Technology can be
seen as both a driving force for innovation and as an enabler of change
45 Continued inequalities as a key societal challenge driving innovation in
welfare and education service sectors also in cross sector services of
education and health and welfare and education
Continued inequalities were identified as a key driving force for innovation within
both welfare and education sectors and in services which straddle the boundary
between education and health services and education and welfare services
Inequalities stem from issues of migration social originbackground
unemployment disability and gender and have been a source of the social
upheaval which has been seen in Europe in recent months
Within health education the link between socio-economic status and health is clear
with people from lower socio-economic groups experiencing poorer health and less
likely engaging in health promoting behaviours In the case of migrants health
messages need to be delivered in a culturally appropriate manner
46 Independent living as a key societal change driving innovation in the
welfare service sector
In terms of disability the emergence and spread of the independent living
philosophy has been a key change driving innovation in the welfare service sector
Typically innovation in this field involves new stakeholder roles with a much more
proactive role for service users in all stages of service provision design
implementation monitoring and fine tuning of services as well as a role in
coordination of different entitlementsservices andor administration and reporting
requirements The boundaries are being pushed further deeper and wider every
day Starting from persons with physical disabilities services are now promoting
active involvement of persons with severe mental disabilities a development that
was deemed impossible only 30 years ago
47 Social roles as a key societal change driving innovation for welfare and
for education service sectors
Changing social roles were identified as a key challenge driving innovation within
the welfare and education sectors These changes are within families and of the
family itself and include changing gender roles and changing family structures (eg
increase in single parent families increase in the numbers of older people living
alone) Families seem to be becoming a sphere of public or community interest
rather than an exclusively private one
Proper lsquosocializationrsquo of children is the key to building viable and sustainable
futures for individuals Early stage family intervention is necessary to prevent the
22
very emergence of conflicts lsquoExternalrsquo interventions often do not reach every day
interaction and thus the root causes of problems This is of significance for family
based projects as well as for care institutions and education providers
48 Organisational changes as a key societal change driving innovation in
welfare service sectors
The shifting of provision of services from the public sector into other sectors such
as independent profit making companies and social enterprises creates new
opportunities for innovation In addition there is an increasing move to provide
services locally in order to be more relevant and responsive and a move to
community based models of care
49 Changing management styles as a key innovation challenge for the
education service sector and in cross sector services of the health and
education sector
Connected to individualism as well as new social roles of individuals family
community and institutions management styles shaped by multi-stakeholder
involvement are gaining importance Community based models do not only increase
the complexity of players involved in the lsquovalue creationrsquo process but also the
enhancement of skill development and personality formation as well as the
fertilization of the educational landscape by innovative ideas expertise and
practices of diverse partners The latter fact also stimulates an increase in cross-
sectoral services (education health and social services) Simultaneously this
situation increases the necessity to spot choose and foster the lsquoinfluencesrsquo and
lsquocombinationsrsquo which realize the highest value through the assessment of social
impact
Increased emphasis is also being placed on illustrating and monitoring
performance Impact measurement and associated tools and practices gain
overarching importance
In terms of changing management styles within the health and education sector an
important aspect is the cooperation of different stakeholders and the involvement
of the community or userrsquos perspective Linked to increased user aspirations
people would like to take part in the development of programs and services With
their special knowledge of their condition for example they can contribute their
expertise within social services
23
5 Other key challenges driving innovation
Sociatal challenges and changes are of course only one driving force of innovation
In addition to these there are other meso and micro level factors which also drive
innovation These include research and development leading to new knowledge
professionally led innovation in response to users needs increasing costs of service
provision and demands for greater efficiency per se and specific political contexts
These other forces are included in the INNOSERV criteria framework in the
lsquochallengesrsquo box These factors are not a key focus for selection of projects for
INNOSERV as they are often very situation specific but will be noted in the case
studies where relevant The factors which prompt or trigger specific innovations
whether socially based or otherwise are not are not mutually exclusive (Bason
2010) and in there is a complex and interacting relationship between a variety of
factors for any given innovation lsquoinstancersquo In addition there are well documented
factors which act to inhibit the development of innovative responses (see Crepaldi
et al 201215)
This work package has sought to identify generic criteria and drivers but it must be
recognised that the dynamics of individual settings and local factors will impact on
the actual processes of adoption
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
24
6 Conclusions and next steps
This report has presented the framework which has been used within the INNOSERV
project to support the choice of innovative case studies and to assist in identifying
the innovation phenomena potential and processes important to future research in
this area The framework has been used to select projects as case studies (see Work
Package 4 report Eurich and Strifler 2012) The framework interlinks aspects of
innovation (novelty type context improvement sustainability) with analysis of
challenges and changes which are acting as driving forces of innovation in social
services As the project is future facing it is proposed that key social challenges
and changes are likely to inform the development of new change paradigms for the
delivery of social services across Europe The framework will inform further
development and testing of concepts through the next stages of the INNOSERVE
programme This process will result in descriptions for the key areas in which future
research on innovation in social services should be taken forward
25
7 Bibliography
Bason C (2010) Leading public sector innovation Co-creating for a better society
Bristol The Policy Press
Bereiter C (2002) Design research for sustained innovation Cognitive Studies
Bulletin of the Japanese Cognitive Society 9 321-327
Christensen CM and Overdorf M (2000) Meeting the Challenge of Disruptive
Change Harvard Business Review March-April
Clark M and Goodwin N (2010) Sustaining innovation in telehealth and telecare
WSDNA briefing paper London The Kings Fund
Crepaldi C De Rosa E And Pesce F (2012) Literature review on innovation in
social services in Europe (sectors of Health Education and Welfare
Services)INNOSERV Work Package 1 report
Department of Health (2011) Innovation Health and Wealth Accelerating Adoption
and Diffusion in the NHS London Department of Health
Eurich J and Strifler A (2012) European compared selection of innovative social
services INNOSERV Work Package 4 report
Fuglsang L (2010) Bricolage and invisible innovation in public service innovation
Journal of Innovation Economics 5 67-87
Greenhalgh T Robert G Macfarlane F Bate P Kyriakidou O (2004) Diffusion of
innovations in service organizations systematic review and recommendations
Milbank Quarterly 82581-629
Hartley J (2005) Innovation in Governance and Public Services Past and Present
Public Money and Management 25127-34
Koch P and Hauknes J (2005) On innovation in the Public Sector Publin report no
D20
Kuhn T (1962) The Structure of Scientific Revolutions Chicago The University of
Chicago Press
Lakatos I and Musgrave A (eds) (1970) Criticism and the growth of knowledge
London Cambridge University Press
May
C Finch T Mair F et al ( 2007) Understanding the implementation of
complex interventions in health care the normalization process model BMC Health
Services Research 2007 7148 doi1011861472-6963-7-148
May et al (2009) Implementing Embedding and Integrating Practices An Outline of
Normalization Process Theory Sociology 43 535-554
Murray R Caulier-Grice J and Mulgan G (2010) The Open Book of Social
Innovation London The Young Foundation
26
OECD (2005) Oslo manual Guidelines for collecting and interpreting innovation
data 3rd
edition
Oliver M (1990) The politics of disablement Basingstoke Macmillan Education Ltd
Osborne S (1998) Naming the Beast Defining and Classifying Service Innovations
in Social Policy Human Relations 51 9 1133-1154
Osborne S and Brown K (2005) Managing Change and Innovation in Public Service
Organizations London Routledge
Phills JA Deiglmeier K and Miller DT (2008) Rediscovering Social Innovation
Stamford Innovation Review 6 4 34-43
Sullivan M (1987) Sociology and Social Welfare London Allen and Unwin
Tidd J and Bessant J (2009) Managing Innovation Integrating Technological
Market and organizational Change 4th
edition Chichester John Wiley and Sons
UK Government Department of Health (2011) Innovation Health and Wealth
Accelerating adoption and diffusion in the NHS London Department of Health
Wolfensburger W (1975) The principle of normalisation in human services Toronto
National Institute on Mental Retardation
27
8 Appendices
Appendix 1 Summary of types and criteria of innovation used in Work Package
3 to identify practices
Identification of social service
Field(s) of service
Logic(s) of service
Self help or mutual aid logic Social care logic Multi-stakeholders logic Social
movements logic Combination
Activities of services delivered
Assistance for persons faced with personal challenges or crises (debt unemployment
drug addiction other) (Re)integration of persons into society (rehabilitation language
training for immigrants other) Services to the labour market (occupational training)
Social housing for disadvantaged groups Care (for the elderly children families )
Treatment and support of people with physical illnesses Treatment and support of
people with mental health problems Combination
Status of the provider organization
Public organization (governmental) Private organization ndash nonnot for profit Private
organization ndash profit Volunteer association Cooperative company or mutual company
Familyneighbourhood Civil society network Combination Other
Target group
Children Youngsters Elder people Unemployed people Poor people Immigrants
Disabled people People with chronic diseases ndash long-term health problems People with
acute or short term health problems No specific target group (eg territory-based social
services provision aiming at strengthen social ties) Combination Other
Size of the organization
Innovation
Type of innovation
New forms of organization resources hybridization new targeted actions new services
non-structural practices other
Innovative character
do the service practices appear to be something new in the field of social services
Origins of innovation
Supply side demand side broader operating factors
Impact on service performance
Effectiveness of service delivery
from user perspective cost effectivenesscapacity building sustainability of
innovation
Quality of provision
28
Socialization quality of life as judged by users and beneficiaries more inclusion
lower risk on exclusion participation of the user transition from institutional to
community based care
Potential wider effects
Promoting social and health equality sustainability new skills and jobs
increased social rights affordability of adequate and high quality health and long-
term care promotion of equality and non-discrimination equal access to adequate
provision
Transferability of innovations between national contexts
29
Appendix 2 levels of innovation identified within INNOSERV Work Package 2
literature review
Organizational level (policy organizational sectors)
New social services designed to face new needs or unmet needs
Search for new solutions to old needs new mechanisms or practices introduced in
preexisting
social services
to improve access to social services (ie more information increased
professionalism in
social work sector)
to guarantee entitlements (rights) for specific groups or minorities
to satisfy the demand for social services in a more complete and broad way
(holistic
approach)
to guarantee more participation and inclusion of citizens
New and increased Cross-Sectoral social services
Cross-Sectoral social services (ie teaching art to children while helping their mothers
for
job seeking and offering jobs for young artists)
Integrated care practices
Tearing down walls between sectors and the role of informal care
Sharing of knowledge
Better integration of Health and Social sector services
Territory based social services that contribute to the creation of training and job
opportunities for disadvantaged people
Solidarity-based social services
Social mediation for impaired and weakened people
Easy access to housing for poor families
New interfaces with clients
Logic(s) of service Self help or mutual aid logic Social care logic Multi-stakeholders
logic
Social movements logic
The development of the self-help sector
Actors New organizations (Cooperative society for social service provision ndashSCOP
Cooperative society as social enterprise with userrsquos involvement ndashSCIC)
New legal forms within structured public frameworks (Italy social cooperatives)
New provider organizations and existing organisations refashioned by new dynamics
New roles and relations among actors
New private organizations for profit and non-profit
Management style in the organization
Regulatory and legislative level
New architecture of the provision system
Socially responsible public contracts and social clauses (outsourcing)
Adherence to EU standards in transitional economies
Impact on institutional framework that shape innovation in social services
New arrangement between one or more government agencies andor external
organization
Organizational level ndash Connection and Cooperation (governance and partnership)
New networks and social movements established in order to design deliver and
finance
social services
Cooperation between sectors actors and different forms of provision
Cooperation between local actors
Increasing communication responsiveness
30
Utilizing connectivity and interdependencies
Modification of organizational systems (models of governance work organisation
number
of involved stakeholders in governance)
Public sector and local authorities as promoters of innovation and promoters of
crosssectoral
policy strategies
Third sector and user as promoters of innovation
Volunteer workers and initiatives launched by a group of citizens
Third sector and userrsquos engagement design (co-design and re-design services)
Joint decision process
Decision-making power not based on capital ownership
Employee and user driven innovation
Partnerships with users family carers and user organizations
Partnership between service users practitioners and academics
Community-based and participative health network in a local territory
Collaboration between public and volunteer organisations (NGOs) or between civil and
local
networks in collaboration with public organisations and social enterprises
New techniques for partnership building and functioning
Impact on social and power relations
Professional level (practitioners)
New practices in social work
Innovative tools (ie Theatre of the Oppressed) and the use of participated methods in
social
work (ie self-help group)
Networking
Individualised supports
New professional skills in social work
The use of informatics and new technologies in social work
Users
Participation and involvement of final users of services in designing delivering and
evaluating social services
Involvement of final users in promoting equality effectiveness and control and
adherence
to the needs of users
Conceptual Level (and value)
New models of society - Social goals participation user involvement community
benefit
New paradigms underlying a new social service concept or service delivery model (ie
new
inclusion paradigm active ageing)
Relationships and trust
Pursuing diversity
Better adjustment to usersrsquo needs more person centred support
More social services provision in less developed regions
New concept of accessibility of the service (ie for Roma families)
The concept of lsquoprogressive universalismrsquo
The Social Care Model
De-institutionalization and community care Improved home-based and community
services
Gender and diversity perspectives
Anti-discrimination and equality process
Increase of the level of recognition of social values objectives paradigms and goals
New models of interaction leading to social innovation processes
31
Public policy level (policy framework programs and social policies)
The new role of the system governance played by central (or local depending on
national
arrangements) government
Impact on public policies new public policy programme measure or intervention
Joint construction of a space for public action and redefinition of public governance
bodies
and methods
Innovative logics for public policies
Innovating the public sector
The new wide attention on anti stigma policies
E-government
Financial and economic sustainability level (and scaling-diffusion-transferability
of innovation)
New ways to overcome budgetary constraints
New approaches to acquire funding
The involvement of private investors
The introduction of special funds
The purchase of innovative practices by final users
Hybridization of resources (market redistribution and reciprocity resources)
New investment sources
Mobilising community resources taking full advantage of all endogenous resources
Improvement in efficiency and effectiveness
Financial and systemic sustainability Impact on the economy
Economic Environmental and Social Sustainability of Territory based social services
Financial tools necessary to territorial social initiatives and the way to unlock them
Capacity of spreading and diffusion
Evaluative level and attention for quality
Affordability availability and accessibility
New standards expected
New feedback loops from users and specialists
Social services of excellence as for quality efficiency and efficacy
New methods and creative tool-kits to strengthen and renew the quality of social care
services
Low-cost (for user) and high level quality of social services
Quality assurance moderation and accreditation mechanisms
New tools for monitoring social services - hearing all voices (users organizations
practioners staff family and friends)
Action research
Alternative economic and social indicators
Social impact and contribution of innovation in social services to social innovation and
social change ndash Assessment of innovation
Learning approach to evaluation ndash lsquoto learn from failuresrsquo
Developmental evaluation
Specifics for the Health sector
Disability from rehabilitation to integration and then to inclusion
Mental Health from segregation to inclusion and community care
HIV from segregationstigmatization to awareness campaigns for promoting self
protection
Innovation in the area of prevention of treatment and in the introduction of new
technologies
Emphasis on an inter-sectoral controlled and steered care in managed care models
replacement of the traditional insurance model
Integrated services
Technological progress
32
Specifics for the Education sector
Inclusive education
Inclusive education and training in collaboration with the civil society
Multicultural education
Integration of disciplines
Alternative schools non-regular schools and informal education
Link between formal and informal education
Community development based approaches
Connection between regular school and the system of social services
Experiential learning
Human rights education
Working lsquothrough relationshipsrsquo with children and young people
Problem based learning methodology
The lsquomedia educationrsquo The use of comics
ICT in schools
E-inclusion
Networks of schools
Improve supplement reinvent and transform learning
Sustained educational improvement
Learning Beyond the Classroom
Spreading a culture that values learning
More personalized approaches to learning
Using the web
Learning with and by not to and from
33
Appendix 3 analysis of social challenges and changes driving innovation
Welfare
Societal
change as
driving force
of innovation
in social
services
Meaning
description
Related
outcomesother
factors
Examples of innovative
responses
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
Empowerment self-
determination choice
The lsquoassertive userrsquo
Demand for more
individualised services of
better quality
Alternativecomplementary
providers
Personalisation
Co-production (new
userprofessional
relationships)
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demand on services
Potential for poor access
to services (from
communication
problems social
isolation)
Multiculturalism
Integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Declining female
caregiving
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
34
Increased demand for
services demand for
formal care
Continued
inequality
Continued
economic
inequality
unemployment
continued poverty
including child
poverty continued
institutionalisation
continued
inequality for
people with
disabilities ethnic
minorities gender
inequalities
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients
with complex
comorbidities increase
in certain diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing demand for
services Increasing
costsneed to make
limited resources go
further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
Decisions about value
marketization
Technological
development
Access to
information new
media technology
Facilitates self
determination increases
expectations and choice
population better
informed about
conditionsservicesright
s and less deferential
Users better able to
35
mobilise
Increased exclusion of
some groups with limited
access
New models of remote
care provision
Ability to exchange
information on quality
and experience
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Increasing costs
Decisions about value
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Organisational
change changing
management
styles
philosophies
Creating new
organisational
forms application
of more responsive
management
processes
performance
management
culture
Integration of
organisationsfunctions
new approaches to
lsquocommissioningrsquo of
organisationsservices
distortions caused by
lsquolocked inrsquo expenditures
(tertiary health care
residential care)
Decentralisation
deinstitutionalisation
marketization liberalisation
The lsquoenabling
statersquo Political
will fiscal space
Impact of financial
crisis competing
priorities for public
funds
Legacy of category-based
(not needs based) social
protection structural
transition
deindustrialisation
Health
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
EmpowermentSelf-
determination choice
Demand for more
individualised services of
better quality
Users better able to mobilise
Assertive lsquouserrsquo
knowledgeable patient
Alternativecomplimentary
providers
36
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demands on
services
Potential for poor access
to services (from
communication
problems social
isolation)
MulticulturalismTrained
health professionals
move to richer countries
integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Declining female
caregiving
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
Increased demand for
formal care services
Continued
inequalities
Unequal
distribution of
health risks and
health
outcomediseases
by socioeconomic
indicators
Unequal access to
care by social
status geography
gender and
ethnicity
Demographic Increase in
numbers of over
Increase in patients with
complex comorbidities
Increasing demand for care
Decisions about value Active
37
change 65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing costsneed to
make limited resources
go further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
ageing paradigm
Technological
development
Access to
information new
media technology
Self determination
expectations choice
population better
informed about
conditionsservicesright
s and less deferential
Ability to exchange
information on quality
and experience
New models of care provision
(eg telehealth care) new
health management systems
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Changing
management
stylesphilosophi
es
Application of
more responsive
management
processes
Decentralisation
deinstitutionalisation
marketization liberalisation
Lifestyle changes Increase in certain
diseases related to
obesity alcohol
and drug
Increasing
costsdemands for care
38
consumption and
stress diabetes
liver disease
anxiety and
depression
Education
Aspirations Rising expectations
by citizens for
better quality of
life
Self determination
choice consumerism
Education outside of formal
setting
Assertive user
Lifelong learningeducation
Migration Historical (post
colonial) migration
pan-EU migration
refugees
New needs for education
eg language and culture
Inequalities social
fragmentation
Social Roles Changing family
structure increase
in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
changing gender
roles rising
female
employment rates
Need to reconcile work
and family life
Parentingfamily skills
for vulnerable
parentsfamilies
Socialization of children
ndash social and emotional
deficits for children in
some environments
Work with families and
communities
Continued
inequalities
Inequality in
educational
accessattainment
by socioeconomic
status gender
people with
disabilities ethnic
minorities
Culture of failure
Promise to deliver social
mobility and economic
improvement
(Leadbeater and Wond
2010 pp 5-20)
Inclusive and multicultural
education
Differential support for
children from
lsquodisadvantagedrsquo
backgrounds
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients with
complex comorbidities
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
New group of older
39
learners
Technological
advance
Access to
information new
media technology
making learning
available in new
ways
Self determination
expectations choice
lsquoAssertive userrsquo
Increased exclusion of
some groups with limited
access
Changing
management
styles
philosophies
Community based models
Globalization Need to provide
educationtraining
which is suited to
modern knowledge
based global
economies
This report for the InnoServ project (grant agreement nr 290542) is supported
under the Socio-economic and Humanities Programme of FP7
Chris Hawker
Faculty of Health Sciences University of Southampton Building 67 University Road Highfield Campus Southampton SO17 1BJ
Tel +44 (0)23 8059 7968
Email CHawkersotonacuk
16
what is to be measured as improvement Hartley maintains that beyond
improvements in service quality and fitness for purpose wider issues of public
value should be considered
The difficulties of measurement and evaluation of innovation in social services need
to be highlighted as the measures of success within a social project are difficult to
define (Bason 2010 Murray et al 2010) Improvement of social services can
include improved quality of life and access to economic and social opportunity
These issues may relate differently in the fields of health welfare and education
For instance quality of life within health may relate to physical health and mental
wellbeing at different stages of life within welfare issues such as equality of access
to housing cultural and community activities and employment are important
The INNOSERV case studies will include available information on the outcomes of
the innovative project although these will likely vary in terms of types of
measurement used by the projects
333 Sustainability
ldquoInnovation is not just about the originating idea but also the whole process
of the successful development implementation and spread of that idea into
widespread userdquo (Department of Health 2011)
It is recognised that change through innovation needs to be sustainable (Bereiter
2002) Achieving a sustainable innovation may involve streamlining of ideas and
altering them to work in everyday practice (Murray et al 2010 12) The
Normalisation Process Model offered by May and colleagues (May et al 2007 May
et al 2009) provides a theoretical explanation within the context of health care of
the processes through which interventions become embedded in practice and then
integrated and sustained
17
4 Drivers of innovation key societal changes
Innovation within social services needs to be relevant to key social challenges and
changes This relates to the purpose of social services in responding to pressing
social demands and societal needs It is therefore important for the INNOSERV
project to have an understanding of the key social challenges and changes driving
innovation to inform the lsquotheoretical trendsrsquo influencing future innovation
requirements As part of this work package we have therefore sought to identify
social challenges and changes which may act as driving forces of innovation and
shape the development of social service lsquoparadigmsrsquo and hence future social
change
Using a lsquoscenario planningrsquo methodology borrowed from management science can
help to test the limits to any paradigm and identify where new paradigm models
may be needed in the future This in turn should help to identify where future
research interests could be located to explore not just opportunities for innovation
within the current paradigm but also where socially driven change is creating new
opportunities (or indeed requirements) for social and social services innovation
Further these challenges feed into social service provision in terms of an imperative
to address new needs and level of need and issues of rising costs
The INNOSERV project undertook such a scenario planning process the outcomes
of which inform what follows here Using an extended literature study on future
social challenges in the European context a number of key factors promoting a
response from and requiring change in social services were identified Individual
partners made further analysis of the important social challenges within their own
national context The factors were synthesised into a table of key social challenges
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
18
(see appendix 3) separately for health welfare and education sectors although
there was much overlap in the challenges relating to each sector
Small groups involving two country based teams in each case took each social
challenge and considered how it may change and develop given current
understandings of the forces affecting change (some forces may promote change
and some may block change) These were considered against potential political
developments economic developments socialsociological change technological
development legallegislative changes and environmental factors with a focus on
volume nature depth timeframe and scale of importance in influencing future
developments in social services
This work informed extensive discussion at the INNOSERV June 2012 Consortium
meeting with regard to the impact of key future developments on innovation and
the choice of projects which should be used to test key innovation developments
and their relevance to future service development
Relevance is represented in the INNOSERV criteria framework by the lsquodriversrsquo box
which includes a number of examples The most significant social challenges and
changes which were identified by the Consortium as most pertinent to innovation in
social services are listed in table 2 (page 19) and are explored further in the
remainder of this section The selection of projects as case studies has included
analysis of which of these social challenges and changes are being addressed (see
Work Package 4 report Eurich and Strifler 2012)
41 Demographic change as a key societal change driving innovation in the
health and welfare social service sectors
Demographic change was identified as a driving force of innovation in both health
and welfare services in Europe Current demographic change is resulting in
increased numbers of people living longer into old age with a particular increase in
the numbers of people aged over 80 This is alongside a reduction in the numbers
of people of working age in part due to a declining birth rate Further socio-cultural
change is leading to concerns about levels of informal care for older people
While many people will want to live active lives in old age some will live with long
periods of ill health and will have complex care needs resulting from multiple co-
morbidities Most however prefer to live as independently as possible
Questions arise about the ability to meet these increasing care demands from
declining tax income bases In addition the specific needs of elderly patients with
dementia represent a unique challenge for nursing staff and the organisation of
nursing services Financing of the rising health care costs for public agencies or for
health insurance schemes requires sustainable solutions and structural reforms
Traditional models of hospital lsquoacutersquo care may not necessarily be appropriate for
meeting these health care needs
This all highlights the need to find alternative solutions to care needs including the
use of technology and reliance on informal carers Current responses which are
relevant to this driver include integration of health and social care services to
increase cost efficiencies use of technological solutions to enhance self care and
care at home and new paradigms such as Active Ageing
19
Table 2 Key social challenges and changes driving innovation
Social
challengesocial
change driving
innovation
Meaning Social service sector
in which driver is key
Demographic
change
Increase in numbers of over 65s Greatest
increase in over 80 age group Increase in
old age dependency ratio
Health sector
Welfare sector
Aspirations Rising expectations of citizens for better
quality of lifebetter care
Health sector
Education sector
Cross sector services of
education and health
Lifestyles Increase in certain diseases related to
obesity alcohol and drug consumption
and stress diabetes liver disease anxiety
and depression
Health sector
Cross sector services of
education and health
Technology Access to information new media
technology
Health sector
Continued
inequalities
Continued economic inequality
unemployment continued poverty
including child poverty continued
institutionalisation continued inequality for
people with disabilities ethnic minorities
gender inequalities impact of socio-
economic status on health outcomes
Welfare sector
Education sector
Cross sector services of
education and health
and welfare and
education
Independent living The approach now adopted by disabled
people to live as ordinary members of
society and in their chosen domestic
setting
Welfare sector
Social roles Changing families increase in single
households increase in single parent
families changing generational relations
(due to longer life expectancy) reduction in
extended families
Changing gender roles rising female
employment rates
Welfare sector
Education sector
Organisational
changes
Creating new organisational forms
application of more responsive
management processes performance
management culture
Welfare sector
Changing
management
styles
Application of more responsive
management processes
Education sector
Cross sector services of
education and health
20
42 Aspirations as a key societal change driving innovation for health and
for education service sectors
Citizen aspirations were identified as a key societal change acting as a driving force
for innovation within both the health and education sectors and across the
boundary of these sectors Across Europe citizens are expecting a better quality of
life including improved outcomes from health and care services and reduced
inequalities
In terms of the health service sector this both derives from and manifests itself in
a population which is more informed about health issues Consequently patients
wish to be more involved in decisions about their health and their health care
options and are more willing and able to participate in the management of their
condition There is less deference to the medical profession and greater willingness
to make demands on health services There are a growing number of patient led
movements which are challenging some medical traditions
This aspect is fundamental both to everyday practice and to the future development
trajectory for health care services While most health aspirations are limited by
current knowledge and medical skill as research and medical advance offer new
choices and opportunities but at greater costs there will be difficult questions for
political debate This could well result in very different more personalised and
lsquopatient managedrsquo models of health care support
In terms of the education service sector individualism and the connected
aspiration of lsquobeing involvedrsquo has been an increasing trend over the past years and
is expected to keep gaining importance This is not only reflected by agendas of
individually shaped curricula or learning arrangements in school but also by the
opening of the public (ie government funded) school system towards involvement
of the community (seniors in school corporate sponsoring external initiatives of
informal learning and personality formation etc) This is reflected in a similar way
in higher education (eg service learning) and adult education (lsquolearning regionsrsquo)
Across the boundary of health and education aspirations coupled with medical
advance lead to a desire for independence of disabled people and those with long
term conditions This highlights the need for health programs focussed on self
esteem
43 Lifestyles as a key societal challenge driving innovation in the health
service sector and also in the cross sector services of health and education
A key social challenge acting as a driving force for innovation for the health sector
and in the cross sector services of education and health is a recognised growth in
lsquolifestylersquo related conditions arising from unhealthy behaviours such as poor diet
alcohol consumption and smoking (although there is limited evidence of a decline
in smoking rates as its harmful effects are less well tolerated) Political investment
in public health is recognised as an important strategic ambition but often not
matched by financial resources Questions about personal responsibility are also
being asked with suggestions that people with poor health behaviours should not
be given the same priority to responsive health care services As other factors
impacting on health outcomes become more responsive to medical advance these
factors are growing in importance in their impact both on wider society and in
improving overall health outcomes
21
44 Technology as a key societal change driving innovation in the health
service sector
The growth in internet and web based technology is leading to an exponential
growth in access to information and new forms of communication More people
now use the internet as their primary health care information resource Web
lsquocommunitiesrsquo are linking and thus empowering people faced with similar health
challenges Telehealthcare solutions to on-going care needs are becoming more
widely available and are changing the patterns of demands for some health care
services Other new technologies for example in transport and in home assistance
devices are enabling greater independence for disabled people
As future generations use and expect more from access to information and
communication services health care services will have to respond to both the
demands and the opportunities created by such technology Technology can be
seen as both a driving force for innovation and as an enabler of change
45 Continued inequalities as a key societal challenge driving innovation in
welfare and education service sectors also in cross sector services of
education and health and welfare and education
Continued inequalities were identified as a key driving force for innovation within
both welfare and education sectors and in services which straddle the boundary
between education and health services and education and welfare services
Inequalities stem from issues of migration social originbackground
unemployment disability and gender and have been a source of the social
upheaval which has been seen in Europe in recent months
Within health education the link between socio-economic status and health is clear
with people from lower socio-economic groups experiencing poorer health and less
likely engaging in health promoting behaviours In the case of migrants health
messages need to be delivered in a culturally appropriate manner
46 Independent living as a key societal change driving innovation in the
welfare service sector
In terms of disability the emergence and spread of the independent living
philosophy has been a key change driving innovation in the welfare service sector
Typically innovation in this field involves new stakeholder roles with a much more
proactive role for service users in all stages of service provision design
implementation monitoring and fine tuning of services as well as a role in
coordination of different entitlementsservices andor administration and reporting
requirements The boundaries are being pushed further deeper and wider every
day Starting from persons with physical disabilities services are now promoting
active involvement of persons with severe mental disabilities a development that
was deemed impossible only 30 years ago
47 Social roles as a key societal change driving innovation for welfare and
for education service sectors
Changing social roles were identified as a key challenge driving innovation within
the welfare and education sectors These changes are within families and of the
family itself and include changing gender roles and changing family structures (eg
increase in single parent families increase in the numbers of older people living
alone) Families seem to be becoming a sphere of public or community interest
rather than an exclusively private one
Proper lsquosocializationrsquo of children is the key to building viable and sustainable
futures for individuals Early stage family intervention is necessary to prevent the
22
very emergence of conflicts lsquoExternalrsquo interventions often do not reach every day
interaction and thus the root causes of problems This is of significance for family
based projects as well as for care institutions and education providers
48 Organisational changes as a key societal change driving innovation in
welfare service sectors
The shifting of provision of services from the public sector into other sectors such
as independent profit making companies and social enterprises creates new
opportunities for innovation In addition there is an increasing move to provide
services locally in order to be more relevant and responsive and a move to
community based models of care
49 Changing management styles as a key innovation challenge for the
education service sector and in cross sector services of the health and
education sector
Connected to individualism as well as new social roles of individuals family
community and institutions management styles shaped by multi-stakeholder
involvement are gaining importance Community based models do not only increase
the complexity of players involved in the lsquovalue creationrsquo process but also the
enhancement of skill development and personality formation as well as the
fertilization of the educational landscape by innovative ideas expertise and
practices of diverse partners The latter fact also stimulates an increase in cross-
sectoral services (education health and social services) Simultaneously this
situation increases the necessity to spot choose and foster the lsquoinfluencesrsquo and
lsquocombinationsrsquo which realize the highest value through the assessment of social
impact
Increased emphasis is also being placed on illustrating and monitoring
performance Impact measurement and associated tools and practices gain
overarching importance
In terms of changing management styles within the health and education sector an
important aspect is the cooperation of different stakeholders and the involvement
of the community or userrsquos perspective Linked to increased user aspirations
people would like to take part in the development of programs and services With
their special knowledge of their condition for example they can contribute their
expertise within social services
23
5 Other key challenges driving innovation
Sociatal challenges and changes are of course only one driving force of innovation
In addition to these there are other meso and micro level factors which also drive
innovation These include research and development leading to new knowledge
professionally led innovation in response to users needs increasing costs of service
provision and demands for greater efficiency per se and specific political contexts
These other forces are included in the INNOSERV criteria framework in the
lsquochallengesrsquo box These factors are not a key focus for selection of projects for
INNOSERV as they are often very situation specific but will be noted in the case
studies where relevant The factors which prompt or trigger specific innovations
whether socially based or otherwise are not are not mutually exclusive (Bason
2010) and in there is a complex and interacting relationship between a variety of
factors for any given innovation lsquoinstancersquo In addition there are well documented
factors which act to inhibit the development of innovative responses (see Crepaldi
et al 201215)
This work package has sought to identify generic criteria and drivers but it must be
recognised that the dynamics of individual settings and local factors will impact on
the actual processes of adoption
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
24
6 Conclusions and next steps
This report has presented the framework which has been used within the INNOSERV
project to support the choice of innovative case studies and to assist in identifying
the innovation phenomena potential and processes important to future research in
this area The framework has been used to select projects as case studies (see Work
Package 4 report Eurich and Strifler 2012) The framework interlinks aspects of
innovation (novelty type context improvement sustainability) with analysis of
challenges and changes which are acting as driving forces of innovation in social
services As the project is future facing it is proposed that key social challenges
and changes are likely to inform the development of new change paradigms for the
delivery of social services across Europe The framework will inform further
development and testing of concepts through the next stages of the INNOSERVE
programme This process will result in descriptions for the key areas in which future
research on innovation in social services should be taken forward
25
7 Bibliography
Bason C (2010) Leading public sector innovation Co-creating for a better society
Bristol The Policy Press
Bereiter C (2002) Design research for sustained innovation Cognitive Studies
Bulletin of the Japanese Cognitive Society 9 321-327
Christensen CM and Overdorf M (2000) Meeting the Challenge of Disruptive
Change Harvard Business Review March-April
Clark M and Goodwin N (2010) Sustaining innovation in telehealth and telecare
WSDNA briefing paper London The Kings Fund
Crepaldi C De Rosa E And Pesce F (2012) Literature review on innovation in
social services in Europe (sectors of Health Education and Welfare
Services)INNOSERV Work Package 1 report
Department of Health (2011) Innovation Health and Wealth Accelerating Adoption
and Diffusion in the NHS London Department of Health
Eurich J and Strifler A (2012) European compared selection of innovative social
services INNOSERV Work Package 4 report
Fuglsang L (2010) Bricolage and invisible innovation in public service innovation
Journal of Innovation Economics 5 67-87
Greenhalgh T Robert G Macfarlane F Bate P Kyriakidou O (2004) Diffusion of
innovations in service organizations systematic review and recommendations
Milbank Quarterly 82581-629
Hartley J (2005) Innovation in Governance and Public Services Past and Present
Public Money and Management 25127-34
Koch P and Hauknes J (2005) On innovation in the Public Sector Publin report no
D20
Kuhn T (1962) The Structure of Scientific Revolutions Chicago The University of
Chicago Press
Lakatos I and Musgrave A (eds) (1970) Criticism and the growth of knowledge
London Cambridge University Press
May
C Finch T Mair F et al ( 2007) Understanding the implementation of
complex interventions in health care the normalization process model BMC Health
Services Research 2007 7148 doi1011861472-6963-7-148
May et al (2009) Implementing Embedding and Integrating Practices An Outline of
Normalization Process Theory Sociology 43 535-554
Murray R Caulier-Grice J and Mulgan G (2010) The Open Book of Social
Innovation London The Young Foundation
26
OECD (2005) Oslo manual Guidelines for collecting and interpreting innovation
data 3rd
edition
Oliver M (1990) The politics of disablement Basingstoke Macmillan Education Ltd
Osborne S (1998) Naming the Beast Defining and Classifying Service Innovations
in Social Policy Human Relations 51 9 1133-1154
Osborne S and Brown K (2005) Managing Change and Innovation in Public Service
Organizations London Routledge
Phills JA Deiglmeier K and Miller DT (2008) Rediscovering Social Innovation
Stamford Innovation Review 6 4 34-43
Sullivan M (1987) Sociology and Social Welfare London Allen and Unwin
Tidd J and Bessant J (2009) Managing Innovation Integrating Technological
Market and organizational Change 4th
edition Chichester John Wiley and Sons
UK Government Department of Health (2011) Innovation Health and Wealth
Accelerating adoption and diffusion in the NHS London Department of Health
Wolfensburger W (1975) The principle of normalisation in human services Toronto
National Institute on Mental Retardation
27
8 Appendices
Appendix 1 Summary of types and criteria of innovation used in Work Package
3 to identify practices
Identification of social service
Field(s) of service
Logic(s) of service
Self help or mutual aid logic Social care logic Multi-stakeholders logic Social
movements logic Combination
Activities of services delivered
Assistance for persons faced with personal challenges or crises (debt unemployment
drug addiction other) (Re)integration of persons into society (rehabilitation language
training for immigrants other) Services to the labour market (occupational training)
Social housing for disadvantaged groups Care (for the elderly children families )
Treatment and support of people with physical illnesses Treatment and support of
people with mental health problems Combination
Status of the provider organization
Public organization (governmental) Private organization ndash nonnot for profit Private
organization ndash profit Volunteer association Cooperative company or mutual company
Familyneighbourhood Civil society network Combination Other
Target group
Children Youngsters Elder people Unemployed people Poor people Immigrants
Disabled people People with chronic diseases ndash long-term health problems People with
acute or short term health problems No specific target group (eg territory-based social
services provision aiming at strengthen social ties) Combination Other
Size of the organization
Innovation
Type of innovation
New forms of organization resources hybridization new targeted actions new services
non-structural practices other
Innovative character
do the service practices appear to be something new in the field of social services
Origins of innovation
Supply side demand side broader operating factors
Impact on service performance
Effectiveness of service delivery
from user perspective cost effectivenesscapacity building sustainability of
innovation
Quality of provision
28
Socialization quality of life as judged by users and beneficiaries more inclusion
lower risk on exclusion participation of the user transition from institutional to
community based care
Potential wider effects
Promoting social and health equality sustainability new skills and jobs
increased social rights affordability of adequate and high quality health and long-
term care promotion of equality and non-discrimination equal access to adequate
provision
Transferability of innovations between national contexts
29
Appendix 2 levels of innovation identified within INNOSERV Work Package 2
literature review
Organizational level (policy organizational sectors)
New social services designed to face new needs or unmet needs
Search for new solutions to old needs new mechanisms or practices introduced in
preexisting
social services
to improve access to social services (ie more information increased
professionalism in
social work sector)
to guarantee entitlements (rights) for specific groups or minorities
to satisfy the demand for social services in a more complete and broad way
(holistic
approach)
to guarantee more participation and inclusion of citizens
New and increased Cross-Sectoral social services
Cross-Sectoral social services (ie teaching art to children while helping their mothers
for
job seeking and offering jobs for young artists)
Integrated care practices
Tearing down walls between sectors and the role of informal care
Sharing of knowledge
Better integration of Health and Social sector services
Territory based social services that contribute to the creation of training and job
opportunities for disadvantaged people
Solidarity-based social services
Social mediation for impaired and weakened people
Easy access to housing for poor families
New interfaces with clients
Logic(s) of service Self help or mutual aid logic Social care logic Multi-stakeholders
logic
Social movements logic
The development of the self-help sector
Actors New organizations (Cooperative society for social service provision ndashSCOP
Cooperative society as social enterprise with userrsquos involvement ndashSCIC)
New legal forms within structured public frameworks (Italy social cooperatives)
New provider organizations and existing organisations refashioned by new dynamics
New roles and relations among actors
New private organizations for profit and non-profit
Management style in the organization
Regulatory and legislative level
New architecture of the provision system
Socially responsible public contracts and social clauses (outsourcing)
Adherence to EU standards in transitional economies
Impact on institutional framework that shape innovation in social services
New arrangement between one or more government agencies andor external
organization
Organizational level ndash Connection and Cooperation (governance and partnership)
New networks and social movements established in order to design deliver and
finance
social services
Cooperation between sectors actors and different forms of provision
Cooperation between local actors
Increasing communication responsiveness
30
Utilizing connectivity and interdependencies
Modification of organizational systems (models of governance work organisation
number
of involved stakeholders in governance)
Public sector and local authorities as promoters of innovation and promoters of
crosssectoral
policy strategies
Third sector and user as promoters of innovation
Volunteer workers and initiatives launched by a group of citizens
Third sector and userrsquos engagement design (co-design and re-design services)
Joint decision process
Decision-making power not based on capital ownership
Employee and user driven innovation
Partnerships with users family carers and user organizations
Partnership between service users practitioners and academics
Community-based and participative health network in a local territory
Collaboration between public and volunteer organisations (NGOs) or between civil and
local
networks in collaboration with public organisations and social enterprises
New techniques for partnership building and functioning
Impact on social and power relations
Professional level (practitioners)
New practices in social work
Innovative tools (ie Theatre of the Oppressed) and the use of participated methods in
social
work (ie self-help group)
Networking
Individualised supports
New professional skills in social work
The use of informatics and new technologies in social work
Users
Participation and involvement of final users of services in designing delivering and
evaluating social services
Involvement of final users in promoting equality effectiveness and control and
adherence
to the needs of users
Conceptual Level (and value)
New models of society - Social goals participation user involvement community
benefit
New paradigms underlying a new social service concept or service delivery model (ie
new
inclusion paradigm active ageing)
Relationships and trust
Pursuing diversity
Better adjustment to usersrsquo needs more person centred support
More social services provision in less developed regions
New concept of accessibility of the service (ie for Roma families)
The concept of lsquoprogressive universalismrsquo
The Social Care Model
De-institutionalization and community care Improved home-based and community
services
Gender and diversity perspectives
Anti-discrimination and equality process
Increase of the level of recognition of social values objectives paradigms and goals
New models of interaction leading to social innovation processes
31
Public policy level (policy framework programs and social policies)
The new role of the system governance played by central (or local depending on
national
arrangements) government
Impact on public policies new public policy programme measure or intervention
Joint construction of a space for public action and redefinition of public governance
bodies
and methods
Innovative logics for public policies
Innovating the public sector
The new wide attention on anti stigma policies
E-government
Financial and economic sustainability level (and scaling-diffusion-transferability
of innovation)
New ways to overcome budgetary constraints
New approaches to acquire funding
The involvement of private investors
The introduction of special funds
The purchase of innovative practices by final users
Hybridization of resources (market redistribution and reciprocity resources)
New investment sources
Mobilising community resources taking full advantage of all endogenous resources
Improvement in efficiency and effectiveness
Financial and systemic sustainability Impact on the economy
Economic Environmental and Social Sustainability of Territory based social services
Financial tools necessary to territorial social initiatives and the way to unlock them
Capacity of spreading and diffusion
Evaluative level and attention for quality
Affordability availability and accessibility
New standards expected
New feedback loops from users and specialists
Social services of excellence as for quality efficiency and efficacy
New methods and creative tool-kits to strengthen and renew the quality of social care
services
Low-cost (for user) and high level quality of social services
Quality assurance moderation and accreditation mechanisms
New tools for monitoring social services - hearing all voices (users organizations
practioners staff family and friends)
Action research
Alternative economic and social indicators
Social impact and contribution of innovation in social services to social innovation and
social change ndash Assessment of innovation
Learning approach to evaluation ndash lsquoto learn from failuresrsquo
Developmental evaluation
Specifics for the Health sector
Disability from rehabilitation to integration and then to inclusion
Mental Health from segregation to inclusion and community care
HIV from segregationstigmatization to awareness campaigns for promoting self
protection
Innovation in the area of prevention of treatment and in the introduction of new
technologies
Emphasis on an inter-sectoral controlled and steered care in managed care models
replacement of the traditional insurance model
Integrated services
Technological progress
32
Specifics for the Education sector
Inclusive education
Inclusive education and training in collaboration with the civil society
Multicultural education
Integration of disciplines
Alternative schools non-regular schools and informal education
Link between formal and informal education
Community development based approaches
Connection between regular school and the system of social services
Experiential learning
Human rights education
Working lsquothrough relationshipsrsquo with children and young people
Problem based learning methodology
The lsquomedia educationrsquo The use of comics
ICT in schools
E-inclusion
Networks of schools
Improve supplement reinvent and transform learning
Sustained educational improvement
Learning Beyond the Classroom
Spreading a culture that values learning
More personalized approaches to learning
Using the web
Learning with and by not to and from
33
Appendix 3 analysis of social challenges and changes driving innovation
Welfare
Societal
change as
driving force
of innovation
in social
services
Meaning
description
Related
outcomesother
factors
Examples of innovative
responses
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
Empowerment self-
determination choice
The lsquoassertive userrsquo
Demand for more
individualised services of
better quality
Alternativecomplementary
providers
Personalisation
Co-production (new
userprofessional
relationships)
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demand on services
Potential for poor access
to services (from
communication
problems social
isolation)
Multiculturalism
Integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Declining female
caregiving
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
34
Increased demand for
services demand for
formal care
Continued
inequality
Continued
economic
inequality
unemployment
continued poverty
including child
poverty continued
institutionalisation
continued
inequality for
people with
disabilities ethnic
minorities gender
inequalities
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients
with complex
comorbidities increase
in certain diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing demand for
services Increasing
costsneed to make
limited resources go
further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
Decisions about value
marketization
Technological
development
Access to
information new
media technology
Facilitates self
determination increases
expectations and choice
population better
informed about
conditionsservicesright
s and less deferential
Users better able to
35
mobilise
Increased exclusion of
some groups with limited
access
New models of remote
care provision
Ability to exchange
information on quality
and experience
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Increasing costs
Decisions about value
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Organisational
change changing
management
styles
philosophies
Creating new
organisational
forms application
of more responsive
management
processes
performance
management
culture
Integration of
organisationsfunctions
new approaches to
lsquocommissioningrsquo of
organisationsservices
distortions caused by
lsquolocked inrsquo expenditures
(tertiary health care
residential care)
Decentralisation
deinstitutionalisation
marketization liberalisation
The lsquoenabling
statersquo Political
will fiscal space
Impact of financial
crisis competing
priorities for public
funds
Legacy of category-based
(not needs based) social
protection structural
transition
deindustrialisation
Health
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
EmpowermentSelf-
determination choice
Demand for more
individualised services of
better quality
Users better able to mobilise
Assertive lsquouserrsquo
knowledgeable patient
Alternativecomplimentary
providers
36
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demands on
services
Potential for poor access
to services (from
communication
problems social
isolation)
MulticulturalismTrained
health professionals
move to richer countries
integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Declining female
caregiving
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
Increased demand for
formal care services
Continued
inequalities
Unequal
distribution of
health risks and
health
outcomediseases
by socioeconomic
indicators
Unequal access to
care by social
status geography
gender and
ethnicity
Demographic Increase in
numbers of over
Increase in patients with
complex comorbidities
Increasing demand for care
Decisions about value Active
37
change 65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing costsneed to
make limited resources
go further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
ageing paradigm
Technological
development
Access to
information new
media technology
Self determination
expectations choice
population better
informed about
conditionsservicesright
s and less deferential
Ability to exchange
information on quality
and experience
New models of care provision
(eg telehealth care) new
health management systems
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Changing
management
stylesphilosophi
es
Application of
more responsive
management
processes
Decentralisation
deinstitutionalisation
marketization liberalisation
Lifestyle changes Increase in certain
diseases related to
obesity alcohol
and drug
Increasing
costsdemands for care
38
consumption and
stress diabetes
liver disease
anxiety and
depression
Education
Aspirations Rising expectations
by citizens for
better quality of
life
Self determination
choice consumerism
Education outside of formal
setting
Assertive user
Lifelong learningeducation
Migration Historical (post
colonial) migration
pan-EU migration
refugees
New needs for education
eg language and culture
Inequalities social
fragmentation
Social Roles Changing family
structure increase
in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
changing gender
roles rising
female
employment rates
Need to reconcile work
and family life
Parentingfamily skills
for vulnerable
parentsfamilies
Socialization of children
ndash social and emotional
deficits for children in
some environments
Work with families and
communities
Continued
inequalities
Inequality in
educational
accessattainment
by socioeconomic
status gender
people with
disabilities ethnic
minorities
Culture of failure
Promise to deliver social
mobility and economic
improvement
(Leadbeater and Wond
2010 pp 5-20)
Inclusive and multicultural
education
Differential support for
children from
lsquodisadvantagedrsquo
backgrounds
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients with
complex comorbidities
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
New group of older
39
learners
Technological
advance
Access to
information new
media technology
making learning
available in new
ways
Self determination
expectations choice
lsquoAssertive userrsquo
Increased exclusion of
some groups with limited
access
Changing
management
styles
philosophies
Community based models
Globalization Need to provide
educationtraining
which is suited to
modern knowledge
based global
economies
This report for the InnoServ project (grant agreement nr 290542) is supported
under the Socio-economic and Humanities Programme of FP7
Chris Hawker
Faculty of Health Sciences University of Southampton Building 67 University Road Highfield Campus Southampton SO17 1BJ
Tel +44 (0)23 8059 7968
Email CHawkersotonacuk
17
4 Drivers of innovation key societal changes
Innovation within social services needs to be relevant to key social challenges and
changes This relates to the purpose of social services in responding to pressing
social demands and societal needs It is therefore important for the INNOSERV
project to have an understanding of the key social challenges and changes driving
innovation to inform the lsquotheoretical trendsrsquo influencing future innovation
requirements As part of this work package we have therefore sought to identify
social challenges and changes which may act as driving forces of innovation and
shape the development of social service lsquoparadigmsrsquo and hence future social
change
Using a lsquoscenario planningrsquo methodology borrowed from management science can
help to test the limits to any paradigm and identify where new paradigm models
may be needed in the future This in turn should help to identify where future
research interests could be located to explore not just opportunities for innovation
within the current paradigm but also where socially driven change is creating new
opportunities (or indeed requirements) for social and social services innovation
Further these challenges feed into social service provision in terms of an imperative
to address new needs and level of need and issues of rising costs
The INNOSERV project undertook such a scenario planning process the outcomes
of which inform what follows here Using an extended literature study on future
social challenges in the European context a number of key factors promoting a
response from and requiring change in social services were identified Individual
partners made further analysis of the important social challenges within their own
national context The factors were synthesised into a table of key social challenges
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
18
(see appendix 3) separately for health welfare and education sectors although
there was much overlap in the challenges relating to each sector
Small groups involving two country based teams in each case took each social
challenge and considered how it may change and develop given current
understandings of the forces affecting change (some forces may promote change
and some may block change) These were considered against potential political
developments economic developments socialsociological change technological
development legallegislative changes and environmental factors with a focus on
volume nature depth timeframe and scale of importance in influencing future
developments in social services
This work informed extensive discussion at the INNOSERV June 2012 Consortium
meeting with regard to the impact of key future developments on innovation and
the choice of projects which should be used to test key innovation developments
and their relevance to future service development
Relevance is represented in the INNOSERV criteria framework by the lsquodriversrsquo box
which includes a number of examples The most significant social challenges and
changes which were identified by the Consortium as most pertinent to innovation in
social services are listed in table 2 (page 19) and are explored further in the
remainder of this section The selection of projects as case studies has included
analysis of which of these social challenges and changes are being addressed (see
Work Package 4 report Eurich and Strifler 2012)
41 Demographic change as a key societal change driving innovation in the
health and welfare social service sectors
Demographic change was identified as a driving force of innovation in both health
and welfare services in Europe Current demographic change is resulting in
increased numbers of people living longer into old age with a particular increase in
the numbers of people aged over 80 This is alongside a reduction in the numbers
of people of working age in part due to a declining birth rate Further socio-cultural
change is leading to concerns about levels of informal care for older people
While many people will want to live active lives in old age some will live with long
periods of ill health and will have complex care needs resulting from multiple co-
morbidities Most however prefer to live as independently as possible
Questions arise about the ability to meet these increasing care demands from
declining tax income bases In addition the specific needs of elderly patients with
dementia represent a unique challenge for nursing staff and the organisation of
nursing services Financing of the rising health care costs for public agencies or for
health insurance schemes requires sustainable solutions and structural reforms
Traditional models of hospital lsquoacutersquo care may not necessarily be appropriate for
meeting these health care needs
This all highlights the need to find alternative solutions to care needs including the
use of technology and reliance on informal carers Current responses which are
relevant to this driver include integration of health and social care services to
increase cost efficiencies use of technological solutions to enhance self care and
care at home and new paradigms such as Active Ageing
19
Table 2 Key social challenges and changes driving innovation
Social
challengesocial
change driving
innovation
Meaning Social service sector
in which driver is key
Demographic
change
Increase in numbers of over 65s Greatest
increase in over 80 age group Increase in
old age dependency ratio
Health sector
Welfare sector
Aspirations Rising expectations of citizens for better
quality of lifebetter care
Health sector
Education sector
Cross sector services of
education and health
Lifestyles Increase in certain diseases related to
obesity alcohol and drug consumption
and stress diabetes liver disease anxiety
and depression
Health sector
Cross sector services of
education and health
Technology Access to information new media
technology
Health sector
Continued
inequalities
Continued economic inequality
unemployment continued poverty
including child poverty continued
institutionalisation continued inequality for
people with disabilities ethnic minorities
gender inequalities impact of socio-
economic status on health outcomes
Welfare sector
Education sector
Cross sector services of
education and health
and welfare and
education
Independent living The approach now adopted by disabled
people to live as ordinary members of
society and in their chosen domestic
setting
Welfare sector
Social roles Changing families increase in single
households increase in single parent
families changing generational relations
(due to longer life expectancy) reduction in
extended families
Changing gender roles rising female
employment rates
Welfare sector
Education sector
Organisational
changes
Creating new organisational forms
application of more responsive
management processes performance
management culture
Welfare sector
Changing
management
styles
Application of more responsive
management processes
Education sector
Cross sector services of
education and health
20
42 Aspirations as a key societal change driving innovation for health and
for education service sectors
Citizen aspirations were identified as a key societal change acting as a driving force
for innovation within both the health and education sectors and across the
boundary of these sectors Across Europe citizens are expecting a better quality of
life including improved outcomes from health and care services and reduced
inequalities
In terms of the health service sector this both derives from and manifests itself in
a population which is more informed about health issues Consequently patients
wish to be more involved in decisions about their health and their health care
options and are more willing and able to participate in the management of their
condition There is less deference to the medical profession and greater willingness
to make demands on health services There are a growing number of patient led
movements which are challenging some medical traditions
This aspect is fundamental both to everyday practice and to the future development
trajectory for health care services While most health aspirations are limited by
current knowledge and medical skill as research and medical advance offer new
choices and opportunities but at greater costs there will be difficult questions for
political debate This could well result in very different more personalised and
lsquopatient managedrsquo models of health care support
In terms of the education service sector individualism and the connected
aspiration of lsquobeing involvedrsquo has been an increasing trend over the past years and
is expected to keep gaining importance This is not only reflected by agendas of
individually shaped curricula or learning arrangements in school but also by the
opening of the public (ie government funded) school system towards involvement
of the community (seniors in school corporate sponsoring external initiatives of
informal learning and personality formation etc) This is reflected in a similar way
in higher education (eg service learning) and adult education (lsquolearning regionsrsquo)
Across the boundary of health and education aspirations coupled with medical
advance lead to a desire for independence of disabled people and those with long
term conditions This highlights the need for health programs focussed on self
esteem
43 Lifestyles as a key societal challenge driving innovation in the health
service sector and also in the cross sector services of health and education
A key social challenge acting as a driving force for innovation for the health sector
and in the cross sector services of education and health is a recognised growth in
lsquolifestylersquo related conditions arising from unhealthy behaviours such as poor diet
alcohol consumption and smoking (although there is limited evidence of a decline
in smoking rates as its harmful effects are less well tolerated) Political investment
in public health is recognised as an important strategic ambition but often not
matched by financial resources Questions about personal responsibility are also
being asked with suggestions that people with poor health behaviours should not
be given the same priority to responsive health care services As other factors
impacting on health outcomes become more responsive to medical advance these
factors are growing in importance in their impact both on wider society and in
improving overall health outcomes
21
44 Technology as a key societal change driving innovation in the health
service sector
The growth in internet and web based technology is leading to an exponential
growth in access to information and new forms of communication More people
now use the internet as their primary health care information resource Web
lsquocommunitiesrsquo are linking and thus empowering people faced with similar health
challenges Telehealthcare solutions to on-going care needs are becoming more
widely available and are changing the patterns of demands for some health care
services Other new technologies for example in transport and in home assistance
devices are enabling greater independence for disabled people
As future generations use and expect more from access to information and
communication services health care services will have to respond to both the
demands and the opportunities created by such technology Technology can be
seen as both a driving force for innovation and as an enabler of change
45 Continued inequalities as a key societal challenge driving innovation in
welfare and education service sectors also in cross sector services of
education and health and welfare and education
Continued inequalities were identified as a key driving force for innovation within
both welfare and education sectors and in services which straddle the boundary
between education and health services and education and welfare services
Inequalities stem from issues of migration social originbackground
unemployment disability and gender and have been a source of the social
upheaval which has been seen in Europe in recent months
Within health education the link between socio-economic status and health is clear
with people from lower socio-economic groups experiencing poorer health and less
likely engaging in health promoting behaviours In the case of migrants health
messages need to be delivered in a culturally appropriate manner
46 Independent living as a key societal change driving innovation in the
welfare service sector
In terms of disability the emergence and spread of the independent living
philosophy has been a key change driving innovation in the welfare service sector
Typically innovation in this field involves new stakeholder roles with a much more
proactive role for service users in all stages of service provision design
implementation monitoring and fine tuning of services as well as a role in
coordination of different entitlementsservices andor administration and reporting
requirements The boundaries are being pushed further deeper and wider every
day Starting from persons with physical disabilities services are now promoting
active involvement of persons with severe mental disabilities a development that
was deemed impossible only 30 years ago
47 Social roles as a key societal change driving innovation for welfare and
for education service sectors
Changing social roles were identified as a key challenge driving innovation within
the welfare and education sectors These changes are within families and of the
family itself and include changing gender roles and changing family structures (eg
increase in single parent families increase in the numbers of older people living
alone) Families seem to be becoming a sphere of public or community interest
rather than an exclusively private one
Proper lsquosocializationrsquo of children is the key to building viable and sustainable
futures for individuals Early stage family intervention is necessary to prevent the
22
very emergence of conflicts lsquoExternalrsquo interventions often do not reach every day
interaction and thus the root causes of problems This is of significance for family
based projects as well as for care institutions and education providers
48 Organisational changes as a key societal change driving innovation in
welfare service sectors
The shifting of provision of services from the public sector into other sectors such
as independent profit making companies and social enterprises creates new
opportunities for innovation In addition there is an increasing move to provide
services locally in order to be more relevant and responsive and a move to
community based models of care
49 Changing management styles as a key innovation challenge for the
education service sector and in cross sector services of the health and
education sector
Connected to individualism as well as new social roles of individuals family
community and institutions management styles shaped by multi-stakeholder
involvement are gaining importance Community based models do not only increase
the complexity of players involved in the lsquovalue creationrsquo process but also the
enhancement of skill development and personality formation as well as the
fertilization of the educational landscape by innovative ideas expertise and
practices of diverse partners The latter fact also stimulates an increase in cross-
sectoral services (education health and social services) Simultaneously this
situation increases the necessity to spot choose and foster the lsquoinfluencesrsquo and
lsquocombinationsrsquo which realize the highest value through the assessment of social
impact
Increased emphasis is also being placed on illustrating and monitoring
performance Impact measurement and associated tools and practices gain
overarching importance
In terms of changing management styles within the health and education sector an
important aspect is the cooperation of different stakeholders and the involvement
of the community or userrsquos perspective Linked to increased user aspirations
people would like to take part in the development of programs and services With
their special knowledge of their condition for example they can contribute their
expertise within social services
23
5 Other key challenges driving innovation
Sociatal challenges and changes are of course only one driving force of innovation
In addition to these there are other meso and micro level factors which also drive
innovation These include research and development leading to new knowledge
professionally led innovation in response to users needs increasing costs of service
provision and demands for greater efficiency per se and specific political contexts
These other forces are included in the INNOSERV criteria framework in the
lsquochallengesrsquo box These factors are not a key focus for selection of projects for
INNOSERV as they are often very situation specific but will be noted in the case
studies where relevant The factors which prompt or trigger specific innovations
whether socially based or otherwise are not are not mutually exclusive (Bason
2010) and in there is a complex and interacting relationship between a variety of
factors for any given innovation lsquoinstancersquo In addition there are well documented
factors which act to inhibit the development of innovative responses (see Crepaldi
et al 201215)
This work package has sought to identify generic criteria and drivers but it must be
recognised that the dynamics of individual settings and local factors will impact on
the actual processes of adoption
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
24
6 Conclusions and next steps
This report has presented the framework which has been used within the INNOSERV
project to support the choice of innovative case studies and to assist in identifying
the innovation phenomena potential and processes important to future research in
this area The framework has been used to select projects as case studies (see Work
Package 4 report Eurich and Strifler 2012) The framework interlinks aspects of
innovation (novelty type context improvement sustainability) with analysis of
challenges and changes which are acting as driving forces of innovation in social
services As the project is future facing it is proposed that key social challenges
and changes are likely to inform the development of new change paradigms for the
delivery of social services across Europe The framework will inform further
development and testing of concepts through the next stages of the INNOSERVE
programme This process will result in descriptions for the key areas in which future
research on innovation in social services should be taken forward
25
7 Bibliography
Bason C (2010) Leading public sector innovation Co-creating for a better society
Bristol The Policy Press
Bereiter C (2002) Design research for sustained innovation Cognitive Studies
Bulletin of the Japanese Cognitive Society 9 321-327
Christensen CM and Overdorf M (2000) Meeting the Challenge of Disruptive
Change Harvard Business Review March-April
Clark M and Goodwin N (2010) Sustaining innovation in telehealth and telecare
WSDNA briefing paper London The Kings Fund
Crepaldi C De Rosa E And Pesce F (2012) Literature review on innovation in
social services in Europe (sectors of Health Education and Welfare
Services)INNOSERV Work Package 1 report
Department of Health (2011) Innovation Health and Wealth Accelerating Adoption
and Diffusion in the NHS London Department of Health
Eurich J and Strifler A (2012) European compared selection of innovative social
services INNOSERV Work Package 4 report
Fuglsang L (2010) Bricolage and invisible innovation in public service innovation
Journal of Innovation Economics 5 67-87
Greenhalgh T Robert G Macfarlane F Bate P Kyriakidou O (2004) Diffusion of
innovations in service organizations systematic review and recommendations
Milbank Quarterly 82581-629
Hartley J (2005) Innovation in Governance and Public Services Past and Present
Public Money and Management 25127-34
Koch P and Hauknes J (2005) On innovation in the Public Sector Publin report no
D20
Kuhn T (1962) The Structure of Scientific Revolutions Chicago The University of
Chicago Press
Lakatos I and Musgrave A (eds) (1970) Criticism and the growth of knowledge
London Cambridge University Press
May
C Finch T Mair F et al ( 2007) Understanding the implementation of
complex interventions in health care the normalization process model BMC Health
Services Research 2007 7148 doi1011861472-6963-7-148
May et al (2009) Implementing Embedding and Integrating Practices An Outline of
Normalization Process Theory Sociology 43 535-554
Murray R Caulier-Grice J and Mulgan G (2010) The Open Book of Social
Innovation London The Young Foundation
26
OECD (2005) Oslo manual Guidelines for collecting and interpreting innovation
data 3rd
edition
Oliver M (1990) The politics of disablement Basingstoke Macmillan Education Ltd
Osborne S (1998) Naming the Beast Defining and Classifying Service Innovations
in Social Policy Human Relations 51 9 1133-1154
Osborne S and Brown K (2005) Managing Change and Innovation in Public Service
Organizations London Routledge
Phills JA Deiglmeier K and Miller DT (2008) Rediscovering Social Innovation
Stamford Innovation Review 6 4 34-43
Sullivan M (1987) Sociology and Social Welfare London Allen and Unwin
Tidd J and Bessant J (2009) Managing Innovation Integrating Technological
Market and organizational Change 4th
edition Chichester John Wiley and Sons
UK Government Department of Health (2011) Innovation Health and Wealth
Accelerating adoption and diffusion in the NHS London Department of Health
Wolfensburger W (1975) The principle of normalisation in human services Toronto
National Institute on Mental Retardation
27
8 Appendices
Appendix 1 Summary of types and criteria of innovation used in Work Package
3 to identify practices
Identification of social service
Field(s) of service
Logic(s) of service
Self help or mutual aid logic Social care logic Multi-stakeholders logic Social
movements logic Combination
Activities of services delivered
Assistance for persons faced with personal challenges or crises (debt unemployment
drug addiction other) (Re)integration of persons into society (rehabilitation language
training for immigrants other) Services to the labour market (occupational training)
Social housing for disadvantaged groups Care (for the elderly children families )
Treatment and support of people with physical illnesses Treatment and support of
people with mental health problems Combination
Status of the provider organization
Public organization (governmental) Private organization ndash nonnot for profit Private
organization ndash profit Volunteer association Cooperative company or mutual company
Familyneighbourhood Civil society network Combination Other
Target group
Children Youngsters Elder people Unemployed people Poor people Immigrants
Disabled people People with chronic diseases ndash long-term health problems People with
acute or short term health problems No specific target group (eg territory-based social
services provision aiming at strengthen social ties) Combination Other
Size of the organization
Innovation
Type of innovation
New forms of organization resources hybridization new targeted actions new services
non-structural practices other
Innovative character
do the service practices appear to be something new in the field of social services
Origins of innovation
Supply side demand side broader operating factors
Impact on service performance
Effectiveness of service delivery
from user perspective cost effectivenesscapacity building sustainability of
innovation
Quality of provision
28
Socialization quality of life as judged by users and beneficiaries more inclusion
lower risk on exclusion participation of the user transition from institutional to
community based care
Potential wider effects
Promoting social and health equality sustainability new skills and jobs
increased social rights affordability of adequate and high quality health and long-
term care promotion of equality and non-discrimination equal access to adequate
provision
Transferability of innovations between national contexts
29
Appendix 2 levels of innovation identified within INNOSERV Work Package 2
literature review
Organizational level (policy organizational sectors)
New social services designed to face new needs or unmet needs
Search for new solutions to old needs new mechanisms or practices introduced in
preexisting
social services
to improve access to social services (ie more information increased
professionalism in
social work sector)
to guarantee entitlements (rights) for specific groups or minorities
to satisfy the demand for social services in a more complete and broad way
(holistic
approach)
to guarantee more participation and inclusion of citizens
New and increased Cross-Sectoral social services
Cross-Sectoral social services (ie teaching art to children while helping their mothers
for
job seeking and offering jobs for young artists)
Integrated care practices
Tearing down walls between sectors and the role of informal care
Sharing of knowledge
Better integration of Health and Social sector services
Territory based social services that contribute to the creation of training and job
opportunities for disadvantaged people
Solidarity-based social services
Social mediation for impaired and weakened people
Easy access to housing for poor families
New interfaces with clients
Logic(s) of service Self help or mutual aid logic Social care logic Multi-stakeholders
logic
Social movements logic
The development of the self-help sector
Actors New organizations (Cooperative society for social service provision ndashSCOP
Cooperative society as social enterprise with userrsquos involvement ndashSCIC)
New legal forms within structured public frameworks (Italy social cooperatives)
New provider organizations and existing organisations refashioned by new dynamics
New roles and relations among actors
New private organizations for profit and non-profit
Management style in the organization
Regulatory and legislative level
New architecture of the provision system
Socially responsible public contracts and social clauses (outsourcing)
Adherence to EU standards in transitional economies
Impact on institutional framework that shape innovation in social services
New arrangement between one or more government agencies andor external
organization
Organizational level ndash Connection and Cooperation (governance and partnership)
New networks and social movements established in order to design deliver and
finance
social services
Cooperation between sectors actors and different forms of provision
Cooperation between local actors
Increasing communication responsiveness
30
Utilizing connectivity and interdependencies
Modification of organizational systems (models of governance work organisation
number
of involved stakeholders in governance)
Public sector and local authorities as promoters of innovation and promoters of
crosssectoral
policy strategies
Third sector and user as promoters of innovation
Volunteer workers and initiatives launched by a group of citizens
Third sector and userrsquos engagement design (co-design and re-design services)
Joint decision process
Decision-making power not based on capital ownership
Employee and user driven innovation
Partnerships with users family carers and user organizations
Partnership between service users practitioners and academics
Community-based and participative health network in a local territory
Collaboration between public and volunteer organisations (NGOs) or between civil and
local
networks in collaboration with public organisations and social enterprises
New techniques for partnership building and functioning
Impact on social and power relations
Professional level (practitioners)
New practices in social work
Innovative tools (ie Theatre of the Oppressed) and the use of participated methods in
social
work (ie self-help group)
Networking
Individualised supports
New professional skills in social work
The use of informatics and new technologies in social work
Users
Participation and involvement of final users of services in designing delivering and
evaluating social services
Involvement of final users in promoting equality effectiveness and control and
adherence
to the needs of users
Conceptual Level (and value)
New models of society - Social goals participation user involvement community
benefit
New paradigms underlying a new social service concept or service delivery model (ie
new
inclusion paradigm active ageing)
Relationships and trust
Pursuing diversity
Better adjustment to usersrsquo needs more person centred support
More social services provision in less developed regions
New concept of accessibility of the service (ie for Roma families)
The concept of lsquoprogressive universalismrsquo
The Social Care Model
De-institutionalization and community care Improved home-based and community
services
Gender and diversity perspectives
Anti-discrimination and equality process
Increase of the level of recognition of social values objectives paradigms and goals
New models of interaction leading to social innovation processes
31
Public policy level (policy framework programs and social policies)
The new role of the system governance played by central (or local depending on
national
arrangements) government
Impact on public policies new public policy programme measure or intervention
Joint construction of a space for public action and redefinition of public governance
bodies
and methods
Innovative logics for public policies
Innovating the public sector
The new wide attention on anti stigma policies
E-government
Financial and economic sustainability level (and scaling-diffusion-transferability
of innovation)
New ways to overcome budgetary constraints
New approaches to acquire funding
The involvement of private investors
The introduction of special funds
The purchase of innovative practices by final users
Hybridization of resources (market redistribution and reciprocity resources)
New investment sources
Mobilising community resources taking full advantage of all endogenous resources
Improvement in efficiency and effectiveness
Financial and systemic sustainability Impact on the economy
Economic Environmental and Social Sustainability of Territory based social services
Financial tools necessary to territorial social initiatives and the way to unlock them
Capacity of spreading and diffusion
Evaluative level and attention for quality
Affordability availability and accessibility
New standards expected
New feedback loops from users and specialists
Social services of excellence as for quality efficiency and efficacy
New methods and creative tool-kits to strengthen and renew the quality of social care
services
Low-cost (for user) and high level quality of social services
Quality assurance moderation and accreditation mechanisms
New tools for monitoring social services - hearing all voices (users organizations
practioners staff family and friends)
Action research
Alternative economic and social indicators
Social impact and contribution of innovation in social services to social innovation and
social change ndash Assessment of innovation
Learning approach to evaluation ndash lsquoto learn from failuresrsquo
Developmental evaluation
Specifics for the Health sector
Disability from rehabilitation to integration and then to inclusion
Mental Health from segregation to inclusion and community care
HIV from segregationstigmatization to awareness campaigns for promoting self
protection
Innovation in the area of prevention of treatment and in the introduction of new
technologies
Emphasis on an inter-sectoral controlled and steered care in managed care models
replacement of the traditional insurance model
Integrated services
Technological progress
32
Specifics for the Education sector
Inclusive education
Inclusive education and training in collaboration with the civil society
Multicultural education
Integration of disciplines
Alternative schools non-regular schools and informal education
Link between formal and informal education
Community development based approaches
Connection between regular school and the system of social services
Experiential learning
Human rights education
Working lsquothrough relationshipsrsquo with children and young people
Problem based learning methodology
The lsquomedia educationrsquo The use of comics
ICT in schools
E-inclusion
Networks of schools
Improve supplement reinvent and transform learning
Sustained educational improvement
Learning Beyond the Classroom
Spreading a culture that values learning
More personalized approaches to learning
Using the web
Learning with and by not to and from
33
Appendix 3 analysis of social challenges and changes driving innovation
Welfare
Societal
change as
driving force
of innovation
in social
services
Meaning
description
Related
outcomesother
factors
Examples of innovative
responses
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
Empowerment self-
determination choice
The lsquoassertive userrsquo
Demand for more
individualised services of
better quality
Alternativecomplementary
providers
Personalisation
Co-production (new
userprofessional
relationships)
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demand on services
Potential for poor access
to services (from
communication
problems social
isolation)
Multiculturalism
Integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Declining female
caregiving
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
34
Increased demand for
services demand for
formal care
Continued
inequality
Continued
economic
inequality
unemployment
continued poverty
including child
poverty continued
institutionalisation
continued
inequality for
people with
disabilities ethnic
minorities gender
inequalities
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients
with complex
comorbidities increase
in certain diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing demand for
services Increasing
costsneed to make
limited resources go
further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
Decisions about value
marketization
Technological
development
Access to
information new
media technology
Facilitates self
determination increases
expectations and choice
population better
informed about
conditionsservicesright
s and less deferential
Users better able to
35
mobilise
Increased exclusion of
some groups with limited
access
New models of remote
care provision
Ability to exchange
information on quality
and experience
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Increasing costs
Decisions about value
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Organisational
change changing
management
styles
philosophies
Creating new
organisational
forms application
of more responsive
management
processes
performance
management
culture
Integration of
organisationsfunctions
new approaches to
lsquocommissioningrsquo of
organisationsservices
distortions caused by
lsquolocked inrsquo expenditures
(tertiary health care
residential care)
Decentralisation
deinstitutionalisation
marketization liberalisation
The lsquoenabling
statersquo Political
will fiscal space
Impact of financial
crisis competing
priorities for public
funds
Legacy of category-based
(not needs based) social
protection structural
transition
deindustrialisation
Health
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
EmpowermentSelf-
determination choice
Demand for more
individualised services of
better quality
Users better able to mobilise
Assertive lsquouserrsquo
knowledgeable patient
Alternativecomplimentary
providers
36
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demands on
services
Potential for poor access
to services (from
communication
problems social
isolation)
MulticulturalismTrained
health professionals
move to richer countries
integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Declining female
caregiving
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
Increased demand for
formal care services
Continued
inequalities
Unequal
distribution of
health risks and
health
outcomediseases
by socioeconomic
indicators
Unequal access to
care by social
status geography
gender and
ethnicity
Demographic Increase in
numbers of over
Increase in patients with
complex comorbidities
Increasing demand for care
Decisions about value Active
37
change 65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing costsneed to
make limited resources
go further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
ageing paradigm
Technological
development
Access to
information new
media technology
Self determination
expectations choice
population better
informed about
conditionsservicesright
s and less deferential
Ability to exchange
information on quality
and experience
New models of care provision
(eg telehealth care) new
health management systems
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Changing
management
stylesphilosophi
es
Application of
more responsive
management
processes
Decentralisation
deinstitutionalisation
marketization liberalisation
Lifestyle changes Increase in certain
diseases related to
obesity alcohol
and drug
Increasing
costsdemands for care
38
consumption and
stress diabetes
liver disease
anxiety and
depression
Education
Aspirations Rising expectations
by citizens for
better quality of
life
Self determination
choice consumerism
Education outside of formal
setting
Assertive user
Lifelong learningeducation
Migration Historical (post
colonial) migration
pan-EU migration
refugees
New needs for education
eg language and culture
Inequalities social
fragmentation
Social Roles Changing family
structure increase
in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
changing gender
roles rising
female
employment rates
Need to reconcile work
and family life
Parentingfamily skills
for vulnerable
parentsfamilies
Socialization of children
ndash social and emotional
deficits for children in
some environments
Work with families and
communities
Continued
inequalities
Inequality in
educational
accessattainment
by socioeconomic
status gender
people with
disabilities ethnic
minorities
Culture of failure
Promise to deliver social
mobility and economic
improvement
(Leadbeater and Wond
2010 pp 5-20)
Inclusive and multicultural
education
Differential support for
children from
lsquodisadvantagedrsquo
backgrounds
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients with
complex comorbidities
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
New group of older
39
learners
Technological
advance
Access to
information new
media technology
making learning
available in new
ways
Self determination
expectations choice
lsquoAssertive userrsquo
Increased exclusion of
some groups with limited
access
Changing
management
styles
philosophies
Community based models
Globalization Need to provide
educationtraining
which is suited to
modern knowledge
based global
economies
This report for the InnoServ project (grant agreement nr 290542) is supported
under the Socio-economic and Humanities Programme of FP7
Chris Hawker
Faculty of Health Sciences University of Southampton Building 67 University Road Highfield Campus Southampton SO17 1BJ
Tel +44 (0)23 8059 7968
Email CHawkersotonacuk
18
(see appendix 3) separately for health welfare and education sectors although
there was much overlap in the challenges relating to each sector
Small groups involving two country based teams in each case took each social
challenge and considered how it may change and develop given current
understandings of the forces affecting change (some forces may promote change
and some may block change) These were considered against potential political
developments economic developments socialsociological change technological
development legallegislative changes and environmental factors with a focus on
volume nature depth timeframe and scale of importance in influencing future
developments in social services
This work informed extensive discussion at the INNOSERV June 2012 Consortium
meeting with regard to the impact of key future developments on innovation and
the choice of projects which should be used to test key innovation developments
and their relevance to future service development
Relevance is represented in the INNOSERV criteria framework by the lsquodriversrsquo box
which includes a number of examples The most significant social challenges and
changes which were identified by the Consortium as most pertinent to innovation in
social services are listed in table 2 (page 19) and are explored further in the
remainder of this section The selection of projects as case studies has included
analysis of which of these social challenges and changes are being addressed (see
Work Package 4 report Eurich and Strifler 2012)
41 Demographic change as a key societal change driving innovation in the
health and welfare social service sectors
Demographic change was identified as a driving force of innovation in both health
and welfare services in Europe Current demographic change is resulting in
increased numbers of people living longer into old age with a particular increase in
the numbers of people aged over 80 This is alongside a reduction in the numbers
of people of working age in part due to a declining birth rate Further socio-cultural
change is leading to concerns about levels of informal care for older people
While many people will want to live active lives in old age some will live with long
periods of ill health and will have complex care needs resulting from multiple co-
morbidities Most however prefer to live as independently as possible
Questions arise about the ability to meet these increasing care demands from
declining tax income bases In addition the specific needs of elderly patients with
dementia represent a unique challenge for nursing staff and the organisation of
nursing services Financing of the rising health care costs for public agencies or for
health insurance schemes requires sustainable solutions and structural reforms
Traditional models of hospital lsquoacutersquo care may not necessarily be appropriate for
meeting these health care needs
This all highlights the need to find alternative solutions to care needs including the
use of technology and reliance on informal carers Current responses which are
relevant to this driver include integration of health and social care services to
increase cost efficiencies use of technological solutions to enhance self care and
care at home and new paradigms such as Active Ageing
19
Table 2 Key social challenges and changes driving innovation
Social
challengesocial
change driving
innovation
Meaning Social service sector
in which driver is key
Demographic
change
Increase in numbers of over 65s Greatest
increase in over 80 age group Increase in
old age dependency ratio
Health sector
Welfare sector
Aspirations Rising expectations of citizens for better
quality of lifebetter care
Health sector
Education sector
Cross sector services of
education and health
Lifestyles Increase in certain diseases related to
obesity alcohol and drug consumption
and stress diabetes liver disease anxiety
and depression
Health sector
Cross sector services of
education and health
Technology Access to information new media
technology
Health sector
Continued
inequalities
Continued economic inequality
unemployment continued poverty
including child poverty continued
institutionalisation continued inequality for
people with disabilities ethnic minorities
gender inequalities impact of socio-
economic status on health outcomes
Welfare sector
Education sector
Cross sector services of
education and health
and welfare and
education
Independent living The approach now adopted by disabled
people to live as ordinary members of
society and in their chosen domestic
setting
Welfare sector
Social roles Changing families increase in single
households increase in single parent
families changing generational relations
(due to longer life expectancy) reduction in
extended families
Changing gender roles rising female
employment rates
Welfare sector
Education sector
Organisational
changes
Creating new organisational forms
application of more responsive
management processes performance
management culture
Welfare sector
Changing
management
styles
Application of more responsive
management processes
Education sector
Cross sector services of
education and health
20
42 Aspirations as a key societal change driving innovation for health and
for education service sectors
Citizen aspirations were identified as a key societal change acting as a driving force
for innovation within both the health and education sectors and across the
boundary of these sectors Across Europe citizens are expecting a better quality of
life including improved outcomes from health and care services and reduced
inequalities
In terms of the health service sector this both derives from and manifests itself in
a population which is more informed about health issues Consequently patients
wish to be more involved in decisions about their health and their health care
options and are more willing and able to participate in the management of their
condition There is less deference to the medical profession and greater willingness
to make demands on health services There are a growing number of patient led
movements which are challenging some medical traditions
This aspect is fundamental both to everyday practice and to the future development
trajectory for health care services While most health aspirations are limited by
current knowledge and medical skill as research and medical advance offer new
choices and opportunities but at greater costs there will be difficult questions for
political debate This could well result in very different more personalised and
lsquopatient managedrsquo models of health care support
In terms of the education service sector individualism and the connected
aspiration of lsquobeing involvedrsquo has been an increasing trend over the past years and
is expected to keep gaining importance This is not only reflected by agendas of
individually shaped curricula or learning arrangements in school but also by the
opening of the public (ie government funded) school system towards involvement
of the community (seniors in school corporate sponsoring external initiatives of
informal learning and personality formation etc) This is reflected in a similar way
in higher education (eg service learning) and adult education (lsquolearning regionsrsquo)
Across the boundary of health and education aspirations coupled with medical
advance lead to a desire for independence of disabled people and those with long
term conditions This highlights the need for health programs focussed on self
esteem
43 Lifestyles as a key societal challenge driving innovation in the health
service sector and also in the cross sector services of health and education
A key social challenge acting as a driving force for innovation for the health sector
and in the cross sector services of education and health is a recognised growth in
lsquolifestylersquo related conditions arising from unhealthy behaviours such as poor diet
alcohol consumption and smoking (although there is limited evidence of a decline
in smoking rates as its harmful effects are less well tolerated) Political investment
in public health is recognised as an important strategic ambition but often not
matched by financial resources Questions about personal responsibility are also
being asked with suggestions that people with poor health behaviours should not
be given the same priority to responsive health care services As other factors
impacting on health outcomes become more responsive to medical advance these
factors are growing in importance in their impact both on wider society and in
improving overall health outcomes
21
44 Technology as a key societal change driving innovation in the health
service sector
The growth in internet and web based technology is leading to an exponential
growth in access to information and new forms of communication More people
now use the internet as their primary health care information resource Web
lsquocommunitiesrsquo are linking and thus empowering people faced with similar health
challenges Telehealthcare solutions to on-going care needs are becoming more
widely available and are changing the patterns of demands for some health care
services Other new technologies for example in transport and in home assistance
devices are enabling greater independence for disabled people
As future generations use and expect more from access to information and
communication services health care services will have to respond to both the
demands and the opportunities created by such technology Technology can be
seen as both a driving force for innovation and as an enabler of change
45 Continued inequalities as a key societal challenge driving innovation in
welfare and education service sectors also in cross sector services of
education and health and welfare and education
Continued inequalities were identified as a key driving force for innovation within
both welfare and education sectors and in services which straddle the boundary
between education and health services and education and welfare services
Inequalities stem from issues of migration social originbackground
unemployment disability and gender and have been a source of the social
upheaval which has been seen in Europe in recent months
Within health education the link between socio-economic status and health is clear
with people from lower socio-economic groups experiencing poorer health and less
likely engaging in health promoting behaviours In the case of migrants health
messages need to be delivered in a culturally appropriate manner
46 Independent living as a key societal change driving innovation in the
welfare service sector
In terms of disability the emergence and spread of the independent living
philosophy has been a key change driving innovation in the welfare service sector
Typically innovation in this field involves new stakeholder roles with a much more
proactive role for service users in all stages of service provision design
implementation monitoring and fine tuning of services as well as a role in
coordination of different entitlementsservices andor administration and reporting
requirements The boundaries are being pushed further deeper and wider every
day Starting from persons with physical disabilities services are now promoting
active involvement of persons with severe mental disabilities a development that
was deemed impossible only 30 years ago
47 Social roles as a key societal change driving innovation for welfare and
for education service sectors
Changing social roles were identified as a key challenge driving innovation within
the welfare and education sectors These changes are within families and of the
family itself and include changing gender roles and changing family structures (eg
increase in single parent families increase in the numbers of older people living
alone) Families seem to be becoming a sphere of public or community interest
rather than an exclusively private one
Proper lsquosocializationrsquo of children is the key to building viable and sustainable
futures for individuals Early stage family intervention is necessary to prevent the
22
very emergence of conflicts lsquoExternalrsquo interventions often do not reach every day
interaction and thus the root causes of problems This is of significance for family
based projects as well as for care institutions and education providers
48 Organisational changes as a key societal change driving innovation in
welfare service sectors
The shifting of provision of services from the public sector into other sectors such
as independent profit making companies and social enterprises creates new
opportunities for innovation In addition there is an increasing move to provide
services locally in order to be more relevant and responsive and a move to
community based models of care
49 Changing management styles as a key innovation challenge for the
education service sector and in cross sector services of the health and
education sector
Connected to individualism as well as new social roles of individuals family
community and institutions management styles shaped by multi-stakeholder
involvement are gaining importance Community based models do not only increase
the complexity of players involved in the lsquovalue creationrsquo process but also the
enhancement of skill development and personality formation as well as the
fertilization of the educational landscape by innovative ideas expertise and
practices of diverse partners The latter fact also stimulates an increase in cross-
sectoral services (education health and social services) Simultaneously this
situation increases the necessity to spot choose and foster the lsquoinfluencesrsquo and
lsquocombinationsrsquo which realize the highest value through the assessment of social
impact
Increased emphasis is also being placed on illustrating and monitoring
performance Impact measurement and associated tools and practices gain
overarching importance
In terms of changing management styles within the health and education sector an
important aspect is the cooperation of different stakeholders and the involvement
of the community or userrsquos perspective Linked to increased user aspirations
people would like to take part in the development of programs and services With
their special knowledge of their condition for example they can contribute their
expertise within social services
23
5 Other key challenges driving innovation
Sociatal challenges and changes are of course only one driving force of innovation
In addition to these there are other meso and micro level factors which also drive
innovation These include research and development leading to new knowledge
professionally led innovation in response to users needs increasing costs of service
provision and demands for greater efficiency per se and specific political contexts
These other forces are included in the INNOSERV criteria framework in the
lsquochallengesrsquo box These factors are not a key focus for selection of projects for
INNOSERV as they are often very situation specific but will be noted in the case
studies where relevant The factors which prompt or trigger specific innovations
whether socially based or otherwise are not are not mutually exclusive (Bason
2010) and in there is a complex and interacting relationship between a variety of
factors for any given innovation lsquoinstancersquo In addition there are well documented
factors which act to inhibit the development of innovative responses (see Crepaldi
et al 201215)
This work package has sought to identify generic criteria and drivers but it must be
recognised that the dynamics of individual settings and local factors will impact on
the actual processes of adoption
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
24
6 Conclusions and next steps
This report has presented the framework which has been used within the INNOSERV
project to support the choice of innovative case studies and to assist in identifying
the innovation phenomena potential and processes important to future research in
this area The framework has been used to select projects as case studies (see Work
Package 4 report Eurich and Strifler 2012) The framework interlinks aspects of
innovation (novelty type context improvement sustainability) with analysis of
challenges and changes which are acting as driving forces of innovation in social
services As the project is future facing it is proposed that key social challenges
and changes are likely to inform the development of new change paradigms for the
delivery of social services across Europe The framework will inform further
development and testing of concepts through the next stages of the INNOSERVE
programme This process will result in descriptions for the key areas in which future
research on innovation in social services should be taken forward
25
7 Bibliography
Bason C (2010) Leading public sector innovation Co-creating for a better society
Bristol The Policy Press
Bereiter C (2002) Design research for sustained innovation Cognitive Studies
Bulletin of the Japanese Cognitive Society 9 321-327
Christensen CM and Overdorf M (2000) Meeting the Challenge of Disruptive
Change Harvard Business Review March-April
Clark M and Goodwin N (2010) Sustaining innovation in telehealth and telecare
WSDNA briefing paper London The Kings Fund
Crepaldi C De Rosa E And Pesce F (2012) Literature review on innovation in
social services in Europe (sectors of Health Education and Welfare
Services)INNOSERV Work Package 1 report
Department of Health (2011) Innovation Health and Wealth Accelerating Adoption
and Diffusion in the NHS London Department of Health
Eurich J and Strifler A (2012) European compared selection of innovative social
services INNOSERV Work Package 4 report
Fuglsang L (2010) Bricolage and invisible innovation in public service innovation
Journal of Innovation Economics 5 67-87
Greenhalgh T Robert G Macfarlane F Bate P Kyriakidou O (2004) Diffusion of
innovations in service organizations systematic review and recommendations
Milbank Quarterly 82581-629
Hartley J (2005) Innovation in Governance and Public Services Past and Present
Public Money and Management 25127-34
Koch P and Hauknes J (2005) On innovation in the Public Sector Publin report no
D20
Kuhn T (1962) The Structure of Scientific Revolutions Chicago The University of
Chicago Press
Lakatos I and Musgrave A (eds) (1970) Criticism and the growth of knowledge
London Cambridge University Press
May
C Finch T Mair F et al ( 2007) Understanding the implementation of
complex interventions in health care the normalization process model BMC Health
Services Research 2007 7148 doi1011861472-6963-7-148
May et al (2009) Implementing Embedding and Integrating Practices An Outline of
Normalization Process Theory Sociology 43 535-554
Murray R Caulier-Grice J and Mulgan G (2010) The Open Book of Social
Innovation London The Young Foundation
26
OECD (2005) Oslo manual Guidelines for collecting and interpreting innovation
data 3rd
edition
Oliver M (1990) The politics of disablement Basingstoke Macmillan Education Ltd
Osborne S (1998) Naming the Beast Defining and Classifying Service Innovations
in Social Policy Human Relations 51 9 1133-1154
Osborne S and Brown K (2005) Managing Change and Innovation in Public Service
Organizations London Routledge
Phills JA Deiglmeier K and Miller DT (2008) Rediscovering Social Innovation
Stamford Innovation Review 6 4 34-43
Sullivan M (1987) Sociology and Social Welfare London Allen and Unwin
Tidd J and Bessant J (2009) Managing Innovation Integrating Technological
Market and organizational Change 4th
edition Chichester John Wiley and Sons
UK Government Department of Health (2011) Innovation Health and Wealth
Accelerating adoption and diffusion in the NHS London Department of Health
Wolfensburger W (1975) The principle of normalisation in human services Toronto
National Institute on Mental Retardation
27
8 Appendices
Appendix 1 Summary of types and criteria of innovation used in Work Package
3 to identify practices
Identification of social service
Field(s) of service
Logic(s) of service
Self help or mutual aid logic Social care logic Multi-stakeholders logic Social
movements logic Combination
Activities of services delivered
Assistance for persons faced with personal challenges or crises (debt unemployment
drug addiction other) (Re)integration of persons into society (rehabilitation language
training for immigrants other) Services to the labour market (occupational training)
Social housing for disadvantaged groups Care (for the elderly children families )
Treatment and support of people with physical illnesses Treatment and support of
people with mental health problems Combination
Status of the provider organization
Public organization (governmental) Private organization ndash nonnot for profit Private
organization ndash profit Volunteer association Cooperative company or mutual company
Familyneighbourhood Civil society network Combination Other
Target group
Children Youngsters Elder people Unemployed people Poor people Immigrants
Disabled people People with chronic diseases ndash long-term health problems People with
acute or short term health problems No specific target group (eg territory-based social
services provision aiming at strengthen social ties) Combination Other
Size of the organization
Innovation
Type of innovation
New forms of organization resources hybridization new targeted actions new services
non-structural practices other
Innovative character
do the service practices appear to be something new in the field of social services
Origins of innovation
Supply side demand side broader operating factors
Impact on service performance
Effectiveness of service delivery
from user perspective cost effectivenesscapacity building sustainability of
innovation
Quality of provision
28
Socialization quality of life as judged by users and beneficiaries more inclusion
lower risk on exclusion participation of the user transition from institutional to
community based care
Potential wider effects
Promoting social and health equality sustainability new skills and jobs
increased social rights affordability of adequate and high quality health and long-
term care promotion of equality and non-discrimination equal access to adequate
provision
Transferability of innovations between national contexts
29
Appendix 2 levels of innovation identified within INNOSERV Work Package 2
literature review
Organizational level (policy organizational sectors)
New social services designed to face new needs or unmet needs
Search for new solutions to old needs new mechanisms or practices introduced in
preexisting
social services
to improve access to social services (ie more information increased
professionalism in
social work sector)
to guarantee entitlements (rights) for specific groups or minorities
to satisfy the demand for social services in a more complete and broad way
(holistic
approach)
to guarantee more participation and inclusion of citizens
New and increased Cross-Sectoral social services
Cross-Sectoral social services (ie teaching art to children while helping their mothers
for
job seeking and offering jobs for young artists)
Integrated care practices
Tearing down walls between sectors and the role of informal care
Sharing of knowledge
Better integration of Health and Social sector services
Territory based social services that contribute to the creation of training and job
opportunities for disadvantaged people
Solidarity-based social services
Social mediation for impaired and weakened people
Easy access to housing for poor families
New interfaces with clients
Logic(s) of service Self help or mutual aid logic Social care logic Multi-stakeholders
logic
Social movements logic
The development of the self-help sector
Actors New organizations (Cooperative society for social service provision ndashSCOP
Cooperative society as social enterprise with userrsquos involvement ndashSCIC)
New legal forms within structured public frameworks (Italy social cooperatives)
New provider organizations and existing organisations refashioned by new dynamics
New roles and relations among actors
New private organizations for profit and non-profit
Management style in the organization
Regulatory and legislative level
New architecture of the provision system
Socially responsible public contracts and social clauses (outsourcing)
Adherence to EU standards in transitional economies
Impact on institutional framework that shape innovation in social services
New arrangement between one or more government agencies andor external
organization
Organizational level ndash Connection and Cooperation (governance and partnership)
New networks and social movements established in order to design deliver and
finance
social services
Cooperation between sectors actors and different forms of provision
Cooperation between local actors
Increasing communication responsiveness
30
Utilizing connectivity and interdependencies
Modification of organizational systems (models of governance work organisation
number
of involved stakeholders in governance)
Public sector and local authorities as promoters of innovation and promoters of
crosssectoral
policy strategies
Third sector and user as promoters of innovation
Volunteer workers and initiatives launched by a group of citizens
Third sector and userrsquos engagement design (co-design and re-design services)
Joint decision process
Decision-making power not based on capital ownership
Employee and user driven innovation
Partnerships with users family carers and user organizations
Partnership between service users practitioners and academics
Community-based and participative health network in a local territory
Collaboration between public and volunteer organisations (NGOs) or between civil and
local
networks in collaboration with public organisations and social enterprises
New techniques for partnership building and functioning
Impact on social and power relations
Professional level (practitioners)
New practices in social work
Innovative tools (ie Theatre of the Oppressed) and the use of participated methods in
social
work (ie self-help group)
Networking
Individualised supports
New professional skills in social work
The use of informatics and new technologies in social work
Users
Participation and involvement of final users of services in designing delivering and
evaluating social services
Involvement of final users in promoting equality effectiveness and control and
adherence
to the needs of users
Conceptual Level (and value)
New models of society - Social goals participation user involvement community
benefit
New paradigms underlying a new social service concept or service delivery model (ie
new
inclusion paradigm active ageing)
Relationships and trust
Pursuing diversity
Better adjustment to usersrsquo needs more person centred support
More social services provision in less developed regions
New concept of accessibility of the service (ie for Roma families)
The concept of lsquoprogressive universalismrsquo
The Social Care Model
De-institutionalization and community care Improved home-based and community
services
Gender and diversity perspectives
Anti-discrimination and equality process
Increase of the level of recognition of social values objectives paradigms and goals
New models of interaction leading to social innovation processes
31
Public policy level (policy framework programs and social policies)
The new role of the system governance played by central (or local depending on
national
arrangements) government
Impact on public policies new public policy programme measure or intervention
Joint construction of a space for public action and redefinition of public governance
bodies
and methods
Innovative logics for public policies
Innovating the public sector
The new wide attention on anti stigma policies
E-government
Financial and economic sustainability level (and scaling-diffusion-transferability
of innovation)
New ways to overcome budgetary constraints
New approaches to acquire funding
The involvement of private investors
The introduction of special funds
The purchase of innovative practices by final users
Hybridization of resources (market redistribution and reciprocity resources)
New investment sources
Mobilising community resources taking full advantage of all endogenous resources
Improvement in efficiency and effectiveness
Financial and systemic sustainability Impact on the economy
Economic Environmental and Social Sustainability of Territory based social services
Financial tools necessary to territorial social initiatives and the way to unlock them
Capacity of spreading and diffusion
Evaluative level and attention for quality
Affordability availability and accessibility
New standards expected
New feedback loops from users and specialists
Social services of excellence as for quality efficiency and efficacy
New methods and creative tool-kits to strengthen and renew the quality of social care
services
Low-cost (for user) and high level quality of social services
Quality assurance moderation and accreditation mechanisms
New tools for monitoring social services - hearing all voices (users organizations
practioners staff family and friends)
Action research
Alternative economic and social indicators
Social impact and contribution of innovation in social services to social innovation and
social change ndash Assessment of innovation
Learning approach to evaluation ndash lsquoto learn from failuresrsquo
Developmental evaluation
Specifics for the Health sector
Disability from rehabilitation to integration and then to inclusion
Mental Health from segregation to inclusion and community care
HIV from segregationstigmatization to awareness campaigns for promoting self
protection
Innovation in the area of prevention of treatment and in the introduction of new
technologies
Emphasis on an inter-sectoral controlled and steered care in managed care models
replacement of the traditional insurance model
Integrated services
Technological progress
32
Specifics for the Education sector
Inclusive education
Inclusive education and training in collaboration with the civil society
Multicultural education
Integration of disciplines
Alternative schools non-regular schools and informal education
Link between formal and informal education
Community development based approaches
Connection between regular school and the system of social services
Experiential learning
Human rights education
Working lsquothrough relationshipsrsquo with children and young people
Problem based learning methodology
The lsquomedia educationrsquo The use of comics
ICT in schools
E-inclusion
Networks of schools
Improve supplement reinvent and transform learning
Sustained educational improvement
Learning Beyond the Classroom
Spreading a culture that values learning
More personalized approaches to learning
Using the web
Learning with and by not to and from
33
Appendix 3 analysis of social challenges and changes driving innovation
Welfare
Societal
change as
driving force
of innovation
in social
services
Meaning
description
Related
outcomesother
factors
Examples of innovative
responses
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
Empowerment self-
determination choice
The lsquoassertive userrsquo
Demand for more
individualised services of
better quality
Alternativecomplementary
providers
Personalisation
Co-production (new
userprofessional
relationships)
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demand on services
Potential for poor access
to services (from
communication
problems social
isolation)
Multiculturalism
Integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Declining female
caregiving
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
34
Increased demand for
services demand for
formal care
Continued
inequality
Continued
economic
inequality
unemployment
continued poverty
including child
poverty continued
institutionalisation
continued
inequality for
people with
disabilities ethnic
minorities gender
inequalities
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients
with complex
comorbidities increase
in certain diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing demand for
services Increasing
costsneed to make
limited resources go
further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
Decisions about value
marketization
Technological
development
Access to
information new
media technology
Facilitates self
determination increases
expectations and choice
population better
informed about
conditionsservicesright
s and less deferential
Users better able to
35
mobilise
Increased exclusion of
some groups with limited
access
New models of remote
care provision
Ability to exchange
information on quality
and experience
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Increasing costs
Decisions about value
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Organisational
change changing
management
styles
philosophies
Creating new
organisational
forms application
of more responsive
management
processes
performance
management
culture
Integration of
organisationsfunctions
new approaches to
lsquocommissioningrsquo of
organisationsservices
distortions caused by
lsquolocked inrsquo expenditures
(tertiary health care
residential care)
Decentralisation
deinstitutionalisation
marketization liberalisation
The lsquoenabling
statersquo Political
will fiscal space
Impact of financial
crisis competing
priorities for public
funds
Legacy of category-based
(not needs based) social
protection structural
transition
deindustrialisation
Health
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
EmpowermentSelf-
determination choice
Demand for more
individualised services of
better quality
Users better able to mobilise
Assertive lsquouserrsquo
knowledgeable patient
Alternativecomplimentary
providers
36
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demands on
services
Potential for poor access
to services (from
communication
problems social
isolation)
MulticulturalismTrained
health professionals
move to richer countries
integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Declining female
caregiving
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
Increased demand for
formal care services
Continued
inequalities
Unequal
distribution of
health risks and
health
outcomediseases
by socioeconomic
indicators
Unequal access to
care by social
status geography
gender and
ethnicity
Demographic Increase in
numbers of over
Increase in patients with
complex comorbidities
Increasing demand for care
Decisions about value Active
37
change 65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing costsneed to
make limited resources
go further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
ageing paradigm
Technological
development
Access to
information new
media technology
Self determination
expectations choice
population better
informed about
conditionsservicesright
s and less deferential
Ability to exchange
information on quality
and experience
New models of care provision
(eg telehealth care) new
health management systems
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Changing
management
stylesphilosophi
es
Application of
more responsive
management
processes
Decentralisation
deinstitutionalisation
marketization liberalisation
Lifestyle changes Increase in certain
diseases related to
obesity alcohol
and drug
Increasing
costsdemands for care
38
consumption and
stress diabetes
liver disease
anxiety and
depression
Education
Aspirations Rising expectations
by citizens for
better quality of
life
Self determination
choice consumerism
Education outside of formal
setting
Assertive user
Lifelong learningeducation
Migration Historical (post
colonial) migration
pan-EU migration
refugees
New needs for education
eg language and culture
Inequalities social
fragmentation
Social Roles Changing family
structure increase
in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
changing gender
roles rising
female
employment rates
Need to reconcile work
and family life
Parentingfamily skills
for vulnerable
parentsfamilies
Socialization of children
ndash social and emotional
deficits for children in
some environments
Work with families and
communities
Continued
inequalities
Inequality in
educational
accessattainment
by socioeconomic
status gender
people with
disabilities ethnic
minorities
Culture of failure
Promise to deliver social
mobility and economic
improvement
(Leadbeater and Wond
2010 pp 5-20)
Inclusive and multicultural
education
Differential support for
children from
lsquodisadvantagedrsquo
backgrounds
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients with
complex comorbidities
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
New group of older
39
learners
Technological
advance
Access to
information new
media technology
making learning
available in new
ways
Self determination
expectations choice
lsquoAssertive userrsquo
Increased exclusion of
some groups with limited
access
Changing
management
styles
philosophies
Community based models
Globalization Need to provide
educationtraining
which is suited to
modern knowledge
based global
economies
This report for the InnoServ project (grant agreement nr 290542) is supported
under the Socio-economic and Humanities Programme of FP7
Chris Hawker
Faculty of Health Sciences University of Southampton Building 67 University Road Highfield Campus Southampton SO17 1BJ
Tel +44 (0)23 8059 7968
Email CHawkersotonacuk
19
Table 2 Key social challenges and changes driving innovation
Social
challengesocial
change driving
innovation
Meaning Social service sector
in which driver is key
Demographic
change
Increase in numbers of over 65s Greatest
increase in over 80 age group Increase in
old age dependency ratio
Health sector
Welfare sector
Aspirations Rising expectations of citizens for better
quality of lifebetter care
Health sector
Education sector
Cross sector services of
education and health
Lifestyles Increase in certain diseases related to
obesity alcohol and drug consumption
and stress diabetes liver disease anxiety
and depression
Health sector
Cross sector services of
education and health
Technology Access to information new media
technology
Health sector
Continued
inequalities
Continued economic inequality
unemployment continued poverty
including child poverty continued
institutionalisation continued inequality for
people with disabilities ethnic minorities
gender inequalities impact of socio-
economic status on health outcomes
Welfare sector
Education sector
Cross sector services of
education and health
and welfare and
education
Independent living The approach now adopted by disabled
people to live as ordinary members of
society and in their chosen domestic
setting
Welfare sector
Social roles Changing families increase in single
households increase in single parent
families changing generational relations
(due to longer life expectancy) reduction in
extended families
Changing gender roles rising female
employment rates
Welfare sector
Education sector
Organisational
changes
Creating new organisational forms
application of more responsive
management processes performance
management culture
Welfare sector
Changing
management
styles
Application of more responsive
management processes
Education sector
Cross sector services of
education and health
20
42 Aspirations as a key societal change driving innovation for health and
for education service sectors
Citizen aspirations were identified as a key societal change acting as a driving force
for innovation within both the health and education sectors and across the
boundary of these sectors Across Europe citizens are expecting a better quality of
life including improved outcomes from health and care services and reduced
inequalities
In terms of the health service sector this both derives from and manifests itself in
a population which is more informed about health issues Consequently patients
wish to be more involved in decisions about their health and their health care
options and are more willing and able to participate in the management of their
condition There is less deference to the medical profession and greater willingness
to make demands on health services There are a growing number of patient led
movements which are challenging some medical traditions
This aspect is fundamental both to everyday practice and to the future development
trajectory for health care services While most health aspirations are limited by
current knowledge and medical skill as research and medical advance offer new
choices and opportunities but at greater costs there will be difficult questions for
political debate This could well result in very different more personalised and
lsquopatient managedrsquo models of health care support
In terms of the education service sector individualism and the connected
aspiration of lsquobeing involvedrsquo has been an increasing trend over the past years and
is expected to keep gaining importance This is not only reflected by agendas of
individually shaped curricula or learning arrangements in school but also by the
opening of the public (ie government funded) school system towards involvement
of the community (seniors in school corporate sponsoring external initiatives of
informal learning and personality formation etc) This is reflected in a similar way
in higher education (eg service learning) and adult education (lsquolearning regionsrsquo)
Across the boundary of health and education aspirations coupled with medical
advance lead to a desire for independence of disabled people and those with long
term conditions This highlights the need for health programs focussed on self
esteem
43 Lifestyles as a key societal challenge driving innovation in the health
service sector and also in the cross sector services of health and education
A key social challenge acting as a driving force for innovation for the health sector
and in the cross sector services of education and health is a recognised growth in
lsquolifestylersquo related conditions arising from unhealthy behaviours such as poor diet
alcohol consumption and smoking (although there is limited evidence of a decline
in smoking rates as its harmful effects are less well tolerated) Political investment
in public health is recognised as an important strategic ambition but often not
matched by financial resources Questions about personal responsibility are also
being asked with suggestions that people with poor health behaviours should not
be given the same priority to responsive health care services As other factors
impacting on health outcomes become more responsive to medical advance these
factors are growing in importance in their impact both on wider society and in
improving overall health outcomes
21
44 Technology as a key societal change driving innovation in the health
service sector
The growth in internet and web based technology is leading to an exponential
growth in access to information and new forms of communication More people
now use the internet as their primary health care information resource Web
lsquocommunitiesrsquo are linking and thus empowering people faced with similar health
challenges Telehealthcare solutions to on-going care needs are becoming more
widely available and are changing the patterns of demands for some health care
services Other new technologies for example in transport and in home assistance
devices are enabling greater independence for disabled people
As future generations use and expect more from access to information and
communication services health care services will have to respond to both the
demands and the opportunities created by such technology Technology can be
seen as both a driving force for innovation and as an enabler of change
45 Continued inequalities as a key societal challenge driving innovation in
welfare and education service sectors also in cross sector services of
education and health and welfare and education
Continued inequalities were identified as a key driving force for innovation within
both welfare and education sectors and in services which straddle the boundary
between education and health services and education and welfare services
Inequalities stem from issues of migration social originbackground
unemployment disability and gender and have been a source of the social
upheaval which has been seen in Europe in recent months
Within health education the link between socio-economic status and health is clear
with people from lower socio-economic groups experiencing poorer health and less
likely engaging in health promoting behaviours In the case of migrants health
messages need to be delivered in a culturally appropriate manner
46 Independent living as a key societal change driving innovation in the
welfare service sector
In terms of disability the emergence and spread of the independent living
philosophy has been a key change driving innovation in the welfare service sector
Typically innovation in this field involves new stakeholder roles with a much more
proactive role for service users in all stages of service provision design
implementation monitoring and fine tuning of services as well as a role in
coordination of different entitlementsservices andor administration and reporting
requirements The boundaries are being pushed further deeper and wider every
day Starting from persons with physical disabilities services are now promoting
active involvement of persons with severe mental disabilities a development that
was deemed impossible only 30 years ago
47 Social roles as a key societal change driving innovation for welfare and
for education service sectors
Changing social roles were identified as a key challenge driving innovation within
the welfare and education sectors These changes are within families and of the
family itself and include changing gender roles and changing family structures (eg
increase in single parent families increase in the numbers of older people living
alone) Families seem to be becoming a sphere of public or community interest
rather than an exclusively private one
Proper lsquosocializationrsquo of children is the key to building viable and sustainable
futures for individuals Early stage family intervention is necessary to prevent the
22
very emergence of conflicts lsquoExternalrsquo interventions often do not reach every day
interaction and thus the root causes of problems This is of significance for family
based projects as well as for care institutions and education providers
48 Organisational changes as a key societal change driving innovation in
welfare service sectors
The shifting of provision of services from the public sector into other sectors such
as independent profit making companies and social enterprises creates new
opportunities for innovation In addition there is an increasing move to provide
services locally in order to be more relevant and responsive and a move to
community based models of care
49 Changing management styles as a key innovation challenge for the
education service sector and in cross sector services of the health and
education sector
Connected to individualism as well as new social roles of individuals family
community and institutions management styles shaped by multi-stakeholder
involvement are gaining importance Community based models do not only increase
the complexity of players involved in the lsquovalue creationrsquo process but also the
enhancement of skill development and personality formation as well as the
fertilization of the educational landscape by innovative ideas expertise and
practices of diverse partners The latter fact also stimulates an increase in cross-
sectoral services (education health and social services) Simultaneously this
situation increases the necessity to spot choose and foster the lsquoinfluencesrsquo and
lsquocombinationsrsquo which realize the highest value through the assessment of social
impact
Increased emphasis is also being placed on illustrating and monitoring
performance Impact measurement and associated tools and practices gain
overarching importance
In terms of changing management styles within the health and education sector an
important aspect is the cooperation of different stakeholders and the involvement
of the community or userrsquos perspective Linked to increased user aspirations
people would like to take part in the development of programs and services With
their special knowledge of their condition for example they can contribute their
expertise within social services
23
5 Other key challenges driving innovation
Sociatal challenges and changes are of course only one driving force of innovation
In addition to these there are other meso and micro level factors which also drive
innovation These include research and development leading to new knowledge
professionally led innovation in response to users needs increasing costs of service
provision and demands for greater efficiency per se and specific political contexts
These other forces are included in the INNOSERV criteria framework in the
lsquochallengesrsquo box These factors are not a key focus for selection of projects for
INNOSERV as they are often very situation specific but will be noted in the case
studies where relevant The factors which prompt or trigger specific innovations
whether socially based or otherwise are not are not mutually exclusive (Bason
2010) and in there is a complex and interacting relationship between a variety of
factors for any given innovation lsquoinstancersquo In addition there are well documented
factors which act to inhibit the development of innovative responses (see Crepaldi
et al 201215)
This work package has sought to identify generic criteria and drivers but it must be
recognised that the dynamics of individual settings and local factors will impact on
the actual processes of adoption
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
24
6 Conclusions and next steps
This report has presented the framework which has been used within the INNOSERV
project to support the choice of innovative case studies and to assist in identifying
the innovation phenomena potential and processes important to future research in
this area The framework has been used to select projects as case studies (see Work
Package 4 report Eurich and Strifler 2012) The framework interlinks aspects of
innovation (novelty type context improvement sustainability) with analysis of
challenges and changes which are acting as driving forces of innovation in social
services As the project is future facing it is proposed that key social challenges
and changes are likely to inform the development of new change paradigms for the
delivery of social services across Europe The framework will inform further
development and testing of concepts through the next stages of the INNOSERVE
programme This process will result in descriptions for the key areas in which future
research on innovation in social services should be taken forward
25
7 Bibliography
Bason C (2010) Leading public sector innovation Co-creating for a better society
Bristol The Policy Press
Bereiter C (2002) Design research for sustained innovation Cognitive Studies
Bulletin of the Japanese Cognitive Society 9 321-327
Christensen CM and Overdorf M (2000) Meeting the Challenge of Disruptive
Change Harvard Business Review March-April
Clark M and Goodwin N (2010) Sustaining innovation in telehealth and telecare
WSDNA briefing paper London The Kings Fund
Crepaldi C De Rosa E And Pesce F (2012) Literature review on innovation in
social services in Europe (sectors of Health Education and Welfare
Services)INNOSERV Work Package 1 report
Department of Health (2011) Innovation Health and Wealth Accelerating Adoption
and Diffusion in the NHS London Department of Health
Eurich J and Strifler A (2012) European compared selection of innovative social
services INNOSERV Work Package 4 report
Fuglsang L (2010) Bricolage and invisible innovation in public service innovation
Journal of Innovation Economics 5 67-87
Greenhalgh T Robert G Macfarlane F Bate P Kyriakidou O (2004) Diffusion of
innovations in service organizations systematic review and recommendations
Milbank Quarterly 82581-629
Hartley J (2005) Innovation in Governance and Public Services Past and Present
Public Money and Management 25127-34
Koch P and Hauknes J (2005) On innovation in the Public Sector Publin report no
D20
Kuhn T (1962) The Structure of Scientific Revolutions Chicago The University of
Chicago Press
Lakatos I and Musgrave A (eds) (1970) Criticism and the growth of knowledge
London Cambridge University Press
May
C Finch T Mair F et al ( 2007) Understanding the implementation of
complex interventions in health care the normalization process model BMC Health
Services Research 2007 7148 doi1011861472-6963-7-148
May et al (2009) Implementing Embedding and Integrating Practices An Outline of
Normalization Process Theory Sociology 43 535-554
Murray R Caulier-Grice J and Mulgan G (2010) The Open Book of Social
Innovation London The Young Foundation
26
OECD (2005) Oslo manual Guidelines for collecting and interpreting innovation
data 3rd
edition
Oliver M (1990) The politics of disablement Basingstoke Macmillan Education Ltd
Osborne S (1998) Naming the Beast Defining and Classifying Service Innovations
in Social Policy Human Relations 51 9 1133-1154
Osborne S and Brown K (2005) Managing Change and Innovation in Public Service
Organizations London Routledge
Phills JA Deiglmeier K and Miller DT (2008) Rediscovering Social Innovation
Stamford Innovation Review 6 4 34-43
Sullivan M (1987) Sociology and Social Welfare London Allen and Unwin
Tidd J and Bessant J (2009) Managing Innovation Integrating Technological
Market and organizational Change 4th
edition Chichester John Wiley and Sons
UK Government Department of Health (2011) Innovation Health and Wealth
Accelerating adoption and diffusion in the NHS London Department of Health
Wolfensburger W (1975) The principle of normalisation in human services Toronto
National Institute on Mental Retardation
27
8 Appendices
Appendix 1 Summary of types and criteria of innovation used in Work Package
3 to identify practices
Identification of social service
Field(s) of service
Logic(s) of service
Self help or mutual aid logic Social care logic Multi-stakeholders logic Social
movements logic Combination
Activities of services delivered
Assistance for persons faced with personal challenges or crises (debt unemployment
drug addiction other) (Re)integration of persons into society (rehabilitation language
training for immigrants other) Services to the labour market (occupational training)
Social housing for disadvantaged groups Care (for the elderly children families )
Treatment and support of people with physical illnesses Treatment and support of
people with mental health problems Combination
Status of the provider organization
Public organization (governmental) Private organization ndash nonnot for profit Private
organization ndash profit Volunteer association Cooperative company or mutual company
Familyneighbourhood Civil society network Combination Other
Target group
Children Youngsters Elder people Unemployed people Poor people Immigrants
Disabled people People with chronic diseases ndash long-term health problems People with
acute or short term health problems No specific target group (eg territory-based social
services provision aiming at strengthen social ties) Combination Other
Size of the organization
Innovation
Type of innovation
New forms of organization resources hybridization new targeted actions new services
non-structural practices other
Innovative character
do the service practices appear to be something new in the field of social services
Origins of innovation
Supply side demand side broader operating factors
Impact on service performance
Effectiveness of service delivery
from user perspective cost effectivenesscapacity building sustainability of
innovation
Quality of provision
28
Socialization quality of life as judged by users and beneficiaries more inclusion
lower risk on exclusion participation of the user transition from institutional to
community based care
Potential wider effects
Promoting social and health equality sustainability new skills and jobs
increased social rights affordability of adequate and high quality health and long-
term care promotion of equality and non-discrimination equal access to adequate
provision
Transferability of innovations between national contexts
29
Appendix 2 levels of innovation identified within INNOSERV Work Package 2
literature review
Organizational level (policy organizational sectors)
New social services designed to face new needs or unmet needs
Search for new solutions to old needs new mechanisms or practices introduced in
preexisting
social services
to improve access to social services (ie more information increased
professionalism in
social work sector)
to guarantee entitlements (rights) for specific groups or minorities
to satisfy the demand for social services in a more complete and broad way
(holistic
approach)
to guarantee more participation and inclusion of citizens
New and increased Cross-Sectoral social services
Cross-Sectoral social services (ie teaching art to children while helping their mothers
for
job seeking and offering jobs for young artists)
Integrated care practices
Tearing down walls between sectors and the role of informal care
Sharing of knowledge
Better integration of Health and Social sector services
Territory based social services that contribute to the creation of training and job
opportunities for disadvantaged people
Solidarity-based social services
Social mediation for impaired and weakened people
Easy access to housing for poor families
New interfaces with clients
Logic(s) of service Self help or mutual aid logic Social care logic Multi-stakeholders
logic
Social movements logic
The development of the self-help sector
Actors New organizations (Cooperative society for social service provision ndashSCOP
Cooperative society as social enterprise with userrsquos involvement ndashSCIC)
New legal forms within structured public frameworks (Italy social cooperatives)
New provider organizations and existing organisations refashioned by new dynamics
New roles and relations among actors
New private organizations for profit and non-profit
Management style in the organization
Regulatory and legislative level
New architecture of the provision system
Socially responsible public contracts and social clauses (outsourcing)
Adherence to EU standards in transitional economies
Impact on institutional framework that shape innovation in social services
New arrangement between one or more government agencies andor external
organization
Organizational level ndash Connection and Cooperation (governance and partnership)
New networks and social movements established in order to design deliver and
finance
social services
Cooperation between sectors actors and different forms of provision
Cooperation between local actors
Increasing communication responsiveness
30
Utilizing connectivity and interdependencies
Modification of organizational systems (models of governance work organisation
number
of involved stakeholders in governance)
Public sector and local authorities as promoters of innovation and promoters of
crosssectoral
policy strategies
Third sector and user as promoters of innovation
Volunteer workers and initiatives launched by a group of citizens
Third sector and userrsquos engagement design (co-design and re-design services)
Joint decision process
Decision-making power not based on capital ownership
Employee and user driven innovation
Partnerships with users family carers and user organizations
Partnership between service users practitioners and academics
Community-based and participative health network in a local territory
Collaboration between public and volunteer organisations (NGOs) or between civil and
local
networks in collaboration with public organisations and social enterprises
New techniques for partnership building and functioning
Impact on social and power relations
Professional level (practitioners)
New practices in social work
Innovative tools (ie Theatre of the Oppressed) and the use of participated methods in
social
work (ie self-help group)
Networking
Individualised supports
New professional skills in social work
The use of informatics and new technologies in social work
Users
Participation and involvement of final users of services in designing delivering and
evaluating social services
Involvement of final users in promoting equality effectiveness and control and
adherence
to the needs of users
Conceptual Level (and value)
New models of society - Social goals participation user involvement community
benefit
New paradigms underlying a new social service concept or service delivery model (ie
new
inclusion paradigm active ageing)
Relationships and trust
Pursuing diversity
Better adjustment to usersrsquo needs more person centred support
More social services provision in less developed regions
New concept of accessibility of the service (ie for Roma families)
The concept of lsquoprogressive universalismrsquo
The Social Care Model
De-institutionalization and community care Improved home-based and community
services
Gender and diversity perspectives
Anti-discrimination and equality process
Increase of the level of recognition of social values objectives paradigms and goals
New models of interaction leading to social innovation processes
31
Public policy level (policy framework programs and social policies)
The new role of the system governance played by central (or local depending on
national
arrangements) government
Impact on public policies new public policy programme measure or intervention
Joint construction of a space for public action and redefinition of public governance
bodies
and methods
Innovative logics for public policies
Innovating the public sector
The new wide attention on anti stigma policies
E-government
Financial and economic sustainability level (and scaling-diffusion-transferability
of innovation)
New ways to overcome budgetary constraints
New approaches to acquire funding
The involvement of private investors
The introduction of special funds
The purchase of innovative practices by final users
Hybridization of resources (market redistribution and reciprocity resources)
New investment sources
Mobilising community resources taking full advantage of all endogenous resources
Improvement in efficiency and effectiveness
Financial and systemic sustainability Impact on the economy
Economic Environmental and Social Sustainability of Territory based social services
Financial tools necessary to territorial social initiatives and the way to unlock them
Capacity of spreading and diffusion
Evaluative level and attention for quality
Affordability availability and accessibility
New standards expected
New feedback loops from users and specialists
Social services of excellence as for quality efficiency and efficacy
New methods and creative tool-kits to strengthen and renew the quality of social care
services
Low-cost (for user) and high level quality of social services
Quality assurance moderation and accreditation mechanisms
New tools for monitoring social services - hearing all voices (users organizations
practioners staff family and friends)
Action research
Alternative economic and social indicators
Social impact and contribution of innovation in social services to social innovation and
social change ndash Assessment of innovation
Learning approach to evaluation ndash lsquoto learn from failuresrsquo
Developmental evaluation
Specifics for the Health sector
Disability from rehabilitation to integration and then to inclusion
Mental Health from segregation to inclusion and community care
HIV from segregationstigmatization to awareness campaigns for promoting self
protection
Innovation in the area of prevention of treatment and in the introduction of new
technologies
Emphasis on an inter-sectoral controlled and steered care in managed care models
replacement of the traditional insurance model
Integrated services
Technological progress
32
Specifics for the Education sector
Inclusive education
Inclusive education and training in collaboration with the civil society
Multicultural education
Integration of disciplines
Alternative schools non-regular schools and informal education
Link between formal and informal education
Community development based approaches
Connection between regular school and the system of social services
Experiential learning
Human rights education
Working lsquothrough relationshipsrsquo with children and young people
Problem based learning methodology
The lsquomedia educationrsquo The use of comics
ICT in schools
E-inclusion
Networks of schools
Improve supplement reinvent and transform learning
Sustained educational improvement
Learning Beyond the Classroom
Spreading a culture that values learning
More personalized approaches to learning
Using the web
Learning with and by not to and from
33
Appendix 3 analysis of social challenges and changes driving innovation
Welfare
Societal
change as
driving force
of innovation
in social
services
Meaning
description
Related
outcomesother
factors
Examples of innovative
responses
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
Empowerment self-
determination choice
The lsquoassertive userrsquo
Demand for more
individualised services of
better quality
Alternativecomplementary
providers
Personalisation
Co-production (new
userprofessional
relationships)
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demand on services
Potential for poor access
to services (from
communication
problems social
isolation)
Multiculturalism
Integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Declining female
caregiving
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
34
Increased demand for
services demand for
formal care
Continued
inequality
Continued
economic
inequality
unemployment
continued poverty
including child
poverty continued
institutionalisation
continued
inequality for
people with
disabilities ethnic
minorities gender
inequalities
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients
with complex
comorbidities increase
in certain diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing demand for
services Increasing
costsneed to make
limited resources go
further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
Decisions about value
marketization
Technological
development
Access to
information new
media technology
Facilitates self
determination increases
expectations and choice
population better
informed about
conditionsservicesright
s and less deferential
Users better able to
35
mobilise
Increased exclusion of
some groups with limited
access
New models of remote
care provision
Ability to exchange
information on quality
and experience
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Increasing costs
Decisions about value
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Organisational
change changing
management
styles
philosophies
Creating new
organisational
forms application
of more responsive
management
processes
performance
management
culture
Integration of
organisationsfunctions
new approaches to
lsquocommissioningrsquo of
organisationsservices
distortions caused by
lsquolocked inrsquo expenditures
(tertiary health care
residential care)
Decentralisation
deinstitutionalisation
marketization liberalisation
The lsquoenabling
statersquo Political
will fiscal space
Impact of financial
crisis competing
priorities for public
funds
Legacy of category-based
(not needs based) social
protection structural
transition
deindustrialisation
Health
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
EmpowermentSelf-
determination choice
Demand for more
individualised services of
better quality
Users better able to mobilise
Assertive lsquouserrsquo
knowledgeable patient
Alternativecomplimentary
providers
36
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demands on
services
Potential for poor access
to services (from
communication
problems social
isolation)
MulticulturalismTrained
health professionals
move to richer countries
integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Declining female
caregiving
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
Increased demand for
formal care services
Continued
inequalities
Unequal
distribution of
health risks and
health
outcomediseases
by socioeconomic
indicators
Unequal access to
care by social
status geography
gender and
ethnicity
Demographic Increase in
numbers of over
Increase in patients with
complex comorbidities
Increasing demand for care
Decisions about value Active
37
change 65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing costsneed to
make limited resources
go further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
ageing paradigm
Technological
development
Access to
information new
media technology
Self determination
expectations choice
population better
informed about
conditionsservicesright
s and less deferential
Ability to exchange
information on quality
and experience
New models of care provision
(eg telehealth care) new
health management systems
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Changing
management
stylesphilosophi
es
Application of
more responsive
management
processes
Decentralisation
deinstitutionalisation
marketization liberalisation
Lifestyle changes Increase in certain
diseases related to
obesity alcohol
and drug
Increasing
costsdemands for care
38
consumption and
stress diabetes
liver disease
anxiety and
depression
Education
Aspirations Rising expectations
by citizens for
better quality of
life
Self determination
choice consumerism
Education outside of formal
setting
Assertive user
Lifelong learningeducation
Migration Historical (post
colonial) migration
pan-EU migration
refugees
New needs for education
eg language and culture
Inequalities social
fragmentation
Social Roles Changing family
structure increase
in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
changing gender
roles rising
female
employment rates
Need to reconcile work
and family life
Parentingfamily skills
for vulnerable
parentsfamilies
Socialization of children
ndash social and emotional
deficits for children in
some environments
Work with families and
communities
Continued
inequalities
Inequality in
educational
accessattainment
by socioeconomic
status gender
people with
disabilities ethnic
minorities
Culture of failure
Promise to deliver social
mobility and economic
improvement
(Leadbeater and Wond
2010 pp 5-20)
Inclusive and multicultural
education
Differential support for
children from
lsquodisadvantagedrsquo
backgrounds
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients with
complex comorbidities
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
New group of older
39
learners
Technological
advance
Access to
information new
media technology
making learning
available in new
ways
Self determination
expectations choice
lsquoAssertive userrsquo
Increased exclusion of
some groups with limited
access
Changing
management
styles
philosophies
Community based models
Globalization Need to provide
educationtraining
which is suited to
modern knowledge
based global
economies
This report for the InnoServ project (grant agreement nr 290542) is supported
under the Socio-economic and Humanities Programme of FP7
Chris Hawker
Faculty of Health Sciences University of Southampton Building 67 University Road Highfield Campus Southampton SO17 1BJ
Tel +44 (0)23 8059 7968
Email CHawkersotonacuk
20
42 Aspirations as a key societal change driving innovation for health and
for education service sectors
Citizen aspirations were identified as a key societal change acting as a driving force
for innovation within both the health and education sectors and across the
boundary of these sectors Across Europe citizens are expecting a better quality of
life including improved outcomes from health and care services and reduced
inequalities
In terms of the health service sector this both derives from and manifests itself in
a population which is more informed about health issues Consequently patients
wish to be more involved in decisions about their health and their health care
options and are more willing and able to participate in the management of their
condition There is less deference to the medical profession and greater willingness
to make demands on health services There are a growing number of patient led
movements which are challenging some medical traditions
This aspect is fundamental both to everyday practice and to the future development
trajectory for health care services While most health aspirations are limited by
current knowledge and medical skill as research and medical advance offer new
choices and opportunities but at greater costs there will be difficult questions for
political debate This could well result in very different more personalised and
lsquopatient managedrsquo models of health care support
In terms of the education service sector individualism and the connected
aspiration of lsquobeing involvedrsquo has been an increasing trend over the past years and
is expected to keep gaining importance This is not only reflected by agendas of
individually shaped curricula or learning arrangements in school but also by the
opening of the public (ie government funded) school system towards involvement
of the community (seniors in school corporate sponsoring external initiatives of
informal learning and personality formation etc) This is reflected in a similar way
in higher education (eg service learning) and adult education (lsquolearning regionsrsquo)
Across the boundary of health and education aspirations coupled with medical
advance lead to a desire for independence of disabled people and those with long
term conditions This highlights the need for health programs focussed on self
esteem
43 Lifestyles as a key societal challenge driving innovation in the health
service sector and also in the cross sector services of health and education
A key social challenge acting as a driving force for innovation for the health sector
and in the cross sector services of education and health is a recognised growth in
lsquolifestylersquo related conditions arising from unhealthy behaviours such as poor diet
alcohol consumption and smoking (although there is limited evidence of a decline
in smoking rates as its harmful effects are less well tolerated) Political investment
in public health is recognised as an important strategic ambition but often not
matched by financial resources Questions about personal responsibility are also
being asked with suggestions that people with poor health behaviours should not
be given the same priority to responsive health care services As other factors
impacting on health outcomes become more responsive to medical advance these
factors are growing in importance in their impact both on wider society and in
improving overall health outcomes
21
44 Technology as a key societal change driving innovation in the health
service sector
The growth in internet and web based technology is leading to an exponential
growth in access to information and new forms of communication More people
now use the internet as their primary health care information resource Web
lsquocommunitiesrsquo are linking and thus empowering people faced with similar health
challenges Telehealthcare solutions to on-going care needs are becoming more
widely available and are changing the patterns of demands for some health care
services Other new technologies for example in transport and in home assistance
devices are enabling greater independence for disabled people
As future generations use and expect more from access to information and
communication services health care services will have to respond to both the
demands and the opportunities created by such technology Technology can be
seen as both a driving force for innovation and as an enabler of change
45 Continued inequalities as a key societal challenge driving innovation in
welfare and education service sectors also in cross sector services of
education and health and welfare and education
Continued inequalities were identified as a key driving force for innovation within
both welfare and education sectors and in services which straddle the boundary
between education and health services and education and welfare services
Inequalities stem from issues of migration social originbackground
unemployment disability and gender and have been a source of the social
upheaval which has been seen in Europe in recent months
Within health education the link between socio-economic status and health is clear
with people from lower socio-economic groups experiencing poorer health and less
likely engaging in health promoting behaviours In the case of migrants health
messages need to be delivered in a culturally appropriate manner
46 Independent living as a key societal change driving innovation in the
welfare service sector
In terms of disability the emergence and spread of the independent living
philosophy has been a key change driving innovation in the welfare service sector
Typically innovation in this field involves new stakeholder roles with a much more
proactive role for service users in all stages of service provision design
implementation monitoring and fine tuning of services as well as a role in
coordination of different entitlementsservices andor administration and reporting
requirements The boundaries are being pushed further deeper and wider every
day Starting from persons with physical disabilities services are now promoting
active involvement of persons with severe mental disabilities a development that
was deemed impossible only 30 years ago
47 Social roles as a key societal change driving innovation for welfare and
for education service sectors
Changing social roles were identified as a key challenge driving innovation within
the welfare and education sectors These changes are within families and of the
family itself and include changing gender roles and changing family structures (eg
increase in single parent families increase in the numbers of older people living
alone) Families seem to be becoming a sphere of public or community interest
rather than an exclusively private one
Proper lsquosocializationrsquo of children is the key to building viable and sustainable
futures for individuals Early stage family intervention is necessary to prevent the
22
very emergence of conflicts lsquoExternalrsquo interventions often do not reach every day
interaction and thus the root causes of problems This is of significance for family
based projects as well as for care institutions and education providers
48 Organisational changes as a key societal change driving innovation in
welfare service sectors
The shifting of provision of services from the public sector into other sectors such
as independent profit making companies and social enterprises creates new
opportunities for innovation In addition there is an increasing move to provide
services locally in order to be more relevant and responsive and a move to
community based models of care
49 Changing management styles as a key innovation challenge for the
education service sector and in cross sector services of the health and
education sector
Connected to individualism as well as new social roles of individuals family
community and institutions management styles shaped by multi-stakeholder
involvement are gaining importance Community based models do not only increase
the complexity of players involved in the lsquovalue creationrsquo process but also the
enhancement of skill development and personality formation as well as the
fertilization of the educational landscape by innovative ideas expertise and
practices of diverse partners The latter fact also stimulates an increase in cross-
sectoral services (education health and social services) Simultaneously this
situation increases the necessity to spot choose and foster the lsquoinfluencesrsquo and
lsquocombinationsrsquo which realize the highest value through the assessment of social
impact
Increased emphasis is also being placed on illustrating and monitoring
performance Impact measurement and associated tools and practices gain
overarching importance
In terms of changing management styles within the health and education sector an
important aspect is the cooperation of different stakeholders and the involvement
of the community or userrsquos perspective Linked to increased user aspirations
people would like to take part in the development of programs and services With
their special knowledge of their condition for example they can contribute their
expertise within social services
23
5 Other key challenges driving innovation
Sociatal challenges and changes are of course only one driving force of innovation
In addition to these there are other meso and micro level factors which also drive
innovation These include research and development leading to new knowledge
professionally led innovation in response to users needs increasing costs of service
provision and demands for greater efficiency per se and specific political contexts
These other forces are included in the INNOSERV criteria framework in the
lsquochallengesrsquo box These factors are not a key focus for selection of projects for
INNOSERV as they are often very situation specific but will be noted in the case
studies where relevant The factors which prompt or trigger specific innovations
whether socially based or otherwise are not are not mutually exclusive (Bason
2010) and in there is a complex and interacting relationship between a variety of
factors for any given innovation lsquoinstancersquo In addition there are well documented
factors which act to inhibit the development of innovative responses (see Crepaldi
et al 201215)
This work package has sought to identify generic criteria and drivers but it must be
recognised that the dynamics of individual settings and local factors will impact on
the actual processes of adoption
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
24
6 Conclusions and next steps
This report has presented the framework which has been used within the INNOSERV
project to support the choice of innovative case studies and to assist in identifying
the innovation phenomena potential and processes important to future research in
this area The framework has been used to select projects as case studies (see Work
Package 4 report Eurich and Strifler 2012) The framework interlinks aspects of
innovation (novelty type context improvement sustainability) with analysis of
challenges and changes which are acting as driving forces of innovation in social
services As the project is future facing it is proposed that key social challenges
and changes are likely to inform the development of new change paradigms for the
delivery of social services across Europe The framework will inform further
development and testing of concepts through the next stages of the INNOSERVE
programme This process will result in descriptions for the key areas in which future
research on innovation in social services should be taken forward
25
7 Bibliography
Bason C (2010) Leading public sector innovation Co-creating for a better society
Bristol The Policy Press
Bereiter C (2002) Design research for sustained innovation Cognitive Studies
Bulletin of the Japanese Cognitive Society 9 321-327
Christensen CM and Overdorf M (2000) Meeting the Challenge of Disruptive
Change Harvard Business Review March-April
Clark M and Goodwin N (2010) Sustaining innovation in telehealth and telecare
WSDNA briefing paper London The Kings Fund
Crepaldi C De Rosa E And Pesce F (2012) Literature review on innovation in
social services in Europe (sectors of Health Education and Welfare
Services)INNOSERV Work Package 1 report
Department of Health (2011) Innovation Health and Wealth Accelerating Adoption
and Diffusion in the NHS London Department of Health
Eurich J and Strifler A (2012) European compared selection of innovative social
services INNOSERV Work Package 4 report
Fuglsang L (2010) Bricolage and invisible innovation in public service innovation
Journal of Innovation Economics 5 67-87
Greenhalgh T Robert G Macfarlane F Bate P Kyriakidou O (2004) Diffusion of
innovations in service organizations systematic review and recommendations
Milbank Quarterly 82581-629
Hartley J (2005) Innovation in Governance and Public Services Past and Present
Public Money and Management 25127-34
Koch P and Hauknes J (2005) On innovation in the Public Sector Publin report no
D20
Kuhn T (1962) The Structure of Scientific Revolutions Chicago The University of
Chicago Press
Lakatos I and Musgrave A (eds) (1970) Criticism and the growth of knowledge
London Cambridge University Press
May
C Finch T Mair F et al ( 2007) Understanding the implementation of
complex interventions in health care the normalization process model BMC Health
Services Research 2007 7148 doi1011861472-6963-7-148
May et al (2009) Implementing Embedding and Integrating Practices An Outline of
Normalization Process Theory Sociology 43 535-554
Murray R Caulier-Grice J and Mulgan G (2010) The Open Book of Social
Innovation London The Young Foundation
26
OECD (2005) Oslo manual Guidelines for collecting and interpreting innovation
data 3rd
edition
Oliver M (1990) The politics of disablement Basingstoke Macmillan Education Ltd
Osborne S (1998) Naming the Beast Defining and Classifying Service Innovations
in Social Policy Human Relations 51 9 1133-1154
Osborne S and Brown K (2005) Managing Change and Innovation in Public Service
Organizations London Routledge
Phills JA Deiglmeier K and Miller DT (2008) Rediscovering Social Innovation
Stamford Innovation Review 6 4 34-43
Sullivan M (1987) Sociology and Social Welfare London Allen and Unwin
Tidd J and Bessant J (2009) Managing Innovation Integrating Technological
Market and organizational Change 4th
edition Chichester John Wiley and Sons
UK Government Department of Health (2011) Innovation Health and Wealth
Accelerating adoption and diffusion in the NHS London Department of Health
Wolfensburger W (1975) The principle of normalisation in human services Toronto
National Institute on Mental Retardation
27
8 Appendices
Appendix 1 Summary of types and criteria of innovation used in Work Package
3 to identify practices
Identification of social service
Field(s) of service
Logic(s) of service
Self help or mutual aid logic Social care logic Multi-stakeholders logic Social
movements logic Combination
Activities of services delivered
Assistance for persons faced with personal challenges or crises (debt unemployment
drug addiction other) (Re)integration of persons into society (rehabilitation language
training for immigrants other) Services to the labour market (occupational training)
Social housing for disadvantaged groups Care (for the elderly children families )
Treatment and support of people with physical illnesses Treatment and support of
people with mental health problems Combination
Status of the provider organization
Public organization (governmental) Private organization ndash nonnot for profit Private
organization ndash profit Volunteer association Cooperative company or mutual company
Familyneighbourhood Civil society network Combination Other
Target group
Children Youngsters Elder people Unemployed people Poor people Immigrants
Disabled people People with chronic diseases ndash long-term health problems People with
acute or short term health problems No specific target group (eg territory-based social
services provision aiming at strengthen social ties) Combination Other
Size of the organization
Innovation
Type of innovation
New forms of organization resources hybridization new targeted actions new services
non-structural practices other
Innovative character
do the service practices appear to be something new in the field of social services
Origins of innovation
Supply side demand side broader operating factors
Impact on service performance
Effectiveness of service delivery
from user perspective cost effectivenesscapacity building sustainability of
innovation
Quality of provision
28
Socialization quality of life as judged by users and beneficiaries more inclusion
lower risk on exclusion participation of the user transition from institutional to
community based care
Potential wider effects
Promoting social and health equality sustainability new skills and jobs
increased social rights affordability of adequate and high quality health and long-
term care promotion of equality and non-discrimination equal access to adequate
provision
Transferability of innovations between national contexts
29
Appendix 2 levels of innovation identified within INNOSERV Work Package 2
literature review
Organizational level (policy organizational sectors)
New social services designed to face new needs or unmet needs
Search for new solutions to old needs new mechanisms or practices introduced in
preexisting
social services
to improve access to social services (ie more information increased
professionalism in
social work sector)
to guarantee entitlements (rights) for specific groups or minorities
to satisfy the demand for social services in a more complete and broad way
(holistic
approach)
to guarantee more participation and inclusion of citizens
New and increased Cross-Sectoral social services
Cross-Sectoral social services (ie teaching art to children while helping their mothers
for
job seeking and offering jobs for young artists)
Integrated care practices
Tearing down walls between sectors and the role of informal care
Sharing of knowledge
Better integration of Health and Social sector services
Territory based social services that contribute to the creation of training and job
opportunities for disadvantaged people
Solidarity-based social services
Social mediation for impaired and weakened people
Easy access to housing for poor families
New interfaces with clients
Logic(s) of service Self help or mutual aid logic Social care logic Multi-stakeholders
logic
Social movements logic
The development of the self-help sector
Actors New organizations (Cooperative society for social service provision ndashSCOP
Cooperative society as social enterprise with userrsquos involvement ndashSCIC)
New legal forms within structured public frameworks (Italy social cooperatives)
New provider organizations and existing organisations refashioned by new dynamics
New roles and relations among actors
New private organizations for profit and non-profit
Management style in the organization
Regulatory and legislative level
New architecture of the provision system
Socially responsible public contracts and social clauses (outsourcing)
Adherence to EU standards in transitional economies
Impact on institutional framework that shape innovation in social services
New arrangement between one or more government agencies andor external
organization
Organizational level ndash Connection and Cooperation (governance and partnership)
New networks and social movements established in order to design deliver and
finance
social services
Cooperation between sectors actors and different forms of provision
Cooperation between local actors
Increasing communication responsiveness
30
Utilizing connectivity and interdependencies
Modification of organizational systems (models of governance work organisation
number
of involved stakeholders in governance)
Public sector and local authorities as promoters of innovation and promoters of
crosssectoral
policy strategies
Third sector and user as promoters of innovation
Volunteer workers and initiatives launched by a group of citizens
Third sector and userrsquos engagement design (co-design and re-design services)
Joint decision process
Decision-making power not based on capital ownership
Employee and user driven innovation
Partnerships with users family carers and user organizations
Partnership between service users practitioners and academics
Community-based and participative health network in a local territory
Collaboration between public and volunteer organisations (NGOs) or between civil and
local
networks in collaboration with public organisations and social enterprises
New techniques for partnership building and functioning
Impact on social and power relations
Professional level (practitioners)
New practices in social work
Innovative tools (ie Theatre of the Oppressed) and the use of participated methods in
social
work (ie self-help group)
Networking
Individualised supports
New professional skills in social work
The use of informatics and new technologies in social work
Users
Participation and involvement of final users of services in designing delivering and
evaluating social services
Involvement of final users in promoting equality effectiveness and control and
adherence
to the needs of users
Conceptual Level (and value)
New models of society - Social goals participation user involvement community
benefit
New paradigms underlying a new social service concept or service delivery model (ie
new
inclusion paradigm active ageing)
Relationships and trust
Pursuing diversity
Better adjustment to usersrsquo needs more person centred support
More social services provision in less developed regions
New concept of accessibility of the service (ie for Roma families)
The concept of lsquoprogressive universalismrsquo
The Social Care Model
De-institutionalization and community care Improved home-based and community
services
Gender and diversity perspectives
Anti-discrimination and equality process
Increase of the level of recognition of social values objectives paradigms and goals
New models of interaction leading to social innovation processes
31
Public policy level (policy framework programs and social policies)
The new role of the system governance played by central (or local depending on
national
arrangements) government
Impact on public policies new public policy programme measure or intervention
Joint construction of a space for public action and redefinition of public governance
bodies
and methods
Innovative logics for public policies
Innovating the public sector
The new wide attention on anti stigma policies
E-government
Financial and economic sustainability level (and scaling-diffusion-transferability
of innovation)
New ways to overcome budgetary constraints
New approaches to acquire funding
The involvement of private investors
The introduction of special funds
The purchase of innovative practices by final users
Hybridization of resources (market redistribution and reciprocity resources)
New investment sources
Mobilising community resources taking full advantage of all endogenous resources
Improvement in efficiency and effectiveness
Financial and systemic sustainability Impact on the economy
Economic Environmental and Social Sustainability of Territory based social services
Financial tools necessary to territorial social initiatives and the way to unlock them
Capacity of spreading and diffusion
Evaluative level and attention for quality
Affordability availability and accessibility
New standards expected
New feedback loops from users and specialists
Social services of excellence as for quality efficiency and efficacy
New methods and creative tool-kits to strengthen and renew the quality of social care
services
Low-cost (for user) and high level quality of social services
Quality assurance moderation and accreditation mechanisms
New tools for monitoring social services - hearing all voices (users organizations
practioners staff family and friends)
Action research
Alternative economic and social indicators
Social impact and contribution of innovation in social services to social innovation and
social change ndash Assessment of innovation
Learning approach to evaluation ndash lsquoto learn from failuresrsquo
Developmental evaluation
Specifics for the Health sector
Disability from rehabilitation to integration and then to inclusion
Mental Health from segregation to inclusion and community care
HIV from segregationstigmatization to awareness campaigns for promoting self
protection
Innovation in the area of prevention of treatment and in the introduction of new
technologies
Emphasis on an inter-sectoral controlled and steered care in managed care models
replacement of the traditional insurance model
Integrated services
Technological progress
32
Specifics for the Education sector
Inclusive education
Inclusive education and training in collaboration with the civil society
Multicultural education
Integration of disciplines
Alternative schools non-regular schools and informal education
Link between formal and informal education
Community development based approaches
Connection between regular school and the system of social services
Experiential learning
Human rights education
Working lsquothrough relationshipsrsquo with children and young people
Problem based learning methodology
The lsquomedia educationrsquo The use of comics
ICT in schools
E-inclusion
Networks of schools
Improve supplement reinvent and transform learning
Sustained educational improvement
Learning Beyond the Classroom
Spreading a culture that values learning
More personalized approaches to learning
Using the web
Learning with and by not to and from
33
Appendix 3 analysis of social challenges and changes driving innovation
Welfare
Societal
change as
driving force
of innovation
in social
services
Meaning
description
Related
outcomesother
factors
Examples of innovative
responses
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
Empowerment self-
determination choice
The lsquoassertive userrsquo
Demand for more
individualised services of
better quality
Alternativecomplementary
providers
Personalisation
Co-production (new
userprofessional
relationships)
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demand on services
Potential for poor access
to services (from
communication
problems social
isolation)
Multiculturalism
Integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Declining female
caregiving
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
34
Increased demand for
services demand for
formal care
Continued
inequality
Continued
economic
inequality
unemployment
continued poverty
including child
poverty continued
institutionalisation
continued
inequality for
people with
disabilities ethnic
minorities gender
inequalities
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients
with complex
comorbidities increase
in certain diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing demand for
services Increasing
costsneed to make
limited resources go
further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
Decisions about value
marketization
Technological
development
Access to
information new
media technology
Facilitates self
determination increases
expectations and choice
population better
informed about
conditionsservicesright
s and less deferential
Users better able to
35
mobilise
Increased exclusion of
some groups with limited
access
New models of remote
care provision
Ability to exchange
information on quality
and experience
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Increasing costs
Decisions about value
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Organisational
change changing
management
styles
philosophies
Creating new
organisational
forms application
of more responsive
management
processes
performance
management
culture
Integration of
organisationsfunctions
new approaches to
lsquocommissioningrsquo of
organisationsservices
distortions caused by
lsquolocked inrsquo expenditures
(tertiary health care
residential care)
Decentralisation
deinstitutionalisation
marketization liberalisation
The lsquoenabling
statersquo Political
will fiscal space
Impact of financial
crisis competing
priorities for public
funds
Legacy of category-based
(not needs based) social
protection structural
transition
deindustrialisation
Health
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
EmpowermentSelf-
determination choice
Demand for more
individualised services of
better quality
Users better able to mobilise
Assertive lsquouserrsquo
knowledgeable patient
Alternativecomplimentary
providers
36
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demands on
services
Potential for poor access
to services (from
communication
problems social
isolation)
MulticulturalismTrained
health professionals
move to richer countries
integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Declining female
caregiving
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
Increased demand for
formal care services
Continued
inequalities
Unequal
distribution of
health risks and
health
outcomediseases
by socioeconomic
indicators
Unequal access to
care by social
status geography
gender and
ethnicity
Demographic Increase in
numbers of over
Increase in patients with
complex comorbidities
Increasing demand for care
Decisions about value Active
37
change 65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing costsneed to
make limited resources
go further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
ageing paradigm
Technological
development
Access to
information new
media technology
Self determination
expectations choice
population better
informed about
conditionsservicesright
s and less deferential
Ability to exchange
information on quality
and experience
New models of care provision
(eg telehealth care) new
health management systems
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Changing
management
stylesphilosophi
es
Application of
more responsive
management
processes
Decentralisation
deinstitutionalisation
marketization liberalisation
Lifestyle changes Increase in certain
diseases related to
obesity alcohol
and drug
Increasing
costsdemands for care
38
consumption and
stress diabetes
liver disease
anxiety and
depression
Education
Aspirations Rising expectations
by citizens for
better quality of
life
Self determination
choice consumerism
Education outside of formal
setting
Assertive user
Lifelong learningeducation
Migration Historical (post
colonial) migration
pan-EU migration
refugees
New needs for education
eg language and culture
Inequalities social
fragmentation
Social Roles Changing family
structure increase
in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
changing gender
roles rising
female
employment rates
Need to reconcile work
and family life
Parentingfamily skills
for vulnerable
parentsfamilies
Socialization of children
ndash social and emotional
deficits for children in
some environments
Work with families and
communities
Continued
inequalities
Inequality in
educational
accessattainment
by socioeconomic
status gender
people with
disabilities ethnic
minorities
Culture of failure
Promise to deliver social
mobility and economic
improvement
(Leadbeater and Wond
2010 pp 5-20)
Inclusive and multicultural
education
Differential support for
children from
lsquodisadvantagedrsquo
backgrounds
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients with
complex comorbidities
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
New group of older
39
learners
Technological
advance
Access to
information new
media technology
making learning
available in new
ways
Self determination
expectations choice
lsquoAssertive userrsquo
Increased exclusion of
some groups with limited
access
Changing
management
styles
philosophies
Community based models
Globalization Need to provide
educationtraining
which is suited to
modern knowledge
based global
economies
This report for the InnoServ project (grant agreement nr 290542) is supported
under the Socio-economic and Humanities Programme of FP7
Chris Hawker
Faculty of Health Sciences University of Southampton Building 67 University Road Highfield Campus Southampton SO17 1BJ
Tel +44 (0)23 8059 7968
Email CHawkersotonacuk
21
44 Technology as a key societal change driving innovation in the health
service sector
The growth in internet and web based technology is leading to an exponential
growth in access to information and new forms of communication More people
now use the internet as their primary health care information resource Web
lsquocommunitiesrsquo are linking and thus empowering people faced with similar health
challenges Telehealthcare solutions to on-going care needs are becoming more
widely available and are changing the patterns of demands for some health care
services Other new technologies for example in transport and in home assistance
devices are enabling greater independence for disabled people
As future generations use and expect more from access to information and
communication services health care services will have to respond to both the
demands and the opportunities created by such technology Technology can be
seen as both a driving force for innovation and as an enabler of change
45 Continued inequalities as a key societal challenge driving innovation in
welfare and education service sectors also in cross sector services of
education and health and welfare and education
Continued inequalities were identified as a key driving force for innovation within
both welfare and education sectors and in services which straddle the boundary
between education and health services and education and welfare services
Inequalities stem from issues of migration social originbackground
unemployment disability and gender and have been a source of the social
upheaval which has been seen in Europe in recent months
Within health education the link between socio-economic status and health is clear
with people from lower socio-economic groups experiencing poorer health and less
likely engaging in health promoting behaviours In the case of migrants health
messages need to be delivered in a culturally appropriate manner
46 Independent living as a key societal change driving innovation in the
welfare service sector
In terms of disability the emergence and spread of the independent living
philosophy has been a key change driving innovation in the welfare service sector
Typically innovation in this field involves new stakeholder roles with a much more
proactive role for service users in all stages of service provision design
implementation monitoring and fine tuning of services as well as a role in
coordination of different entitlementsservices andor administration and reporting
requirements The boundaries are being pushed further deeper and wider every
day Starting from persons with physical disabilities services are now promoting
active involvement of persons with severe mental disabilities a development that
was deemed impossible only 30 years ago
47 Social roles as a key societal change driving innovation for welfare and
for education service sectors
Changing social roles were identified as a key challenge driving innovation within
the welfare and education sectors These changes are within families and of the
family itself and include changing gender roles and changing family structures (eg
increase in single parent families increase in the numbers of older people living
alone) Families seem to be becoming a sphere of public or community interest
rather than an exclusively private one
Proper lsquosocializationrsquo of children is the key to building viable and sustainable
futures for individuals Early stage family intervention is necessary to prevent the
22
very emergence of conflicts lsquoExternalrsquo interventions often do not reach every day
interaction and thus the root causes of problems This is of significance for family
based projects as well as for care institutions and education providers
48 Organisational changes as a key societal change driving innovation in
welfare service sectors
The shifting of provision of services from the public sector into other sectors such
as independent profit making companies and social enterprises creates new
opportunities for innovation In addition there is an increasing move to provide
services locally in order to be more relevant and responsive and a move to
community based models of care
49 Changing management styles as a key innovation challenge for the
education service sector and in cross sector services of the health and
education sector
Connected to individualism as well as new social roles of individuals family
community and institutions management styles shaped by multi-stakeholder
involvement are gaining importance Community based models do not only increase
the complexity of players involved in the lsquovalue creationrsquo process but also the
enhancement of skill development and personality formation as well as the
fertilization of the educational landscape by innovative ideas expertise and
practices of diverse partners The latter fact also stimulates an increase in cross-
sectoral services (education health and social services) Simultaneously this
situation increases the necessity to spot choose and foster the lsquoinfluencesrsquo and
lsquocombinationsrsquo which realize the highest value through the assessment of social
impact
Increased emphasis is also being placed on illustrating and monitoring
performance Impact measurement and associated tools and practices gain
overarching importance
In terms of changing management styles within the health and education sector an
important aspect is the cooperation of different stakeholders and the involvement
of the community or userrsquos perspective Linked to increased user aspirations
people would like to take part in the development of programs and services With
their special knowledge of their condition for example they can contribute their
expertise within social services
23
5 Other key challenges driving innovation
Sociatal challenges and changes are of course only one driving force of innovation
In addition to these there are other meso and micro level factors which also drive
innovation These include research and development leading to new knowledge
professionally led innovation in response to users needs increasing costs of service
provision and demands for greater efficiency per se and specific political contexts
These other forces are included in the INNOSERV criteria framework in the
lsquochallengesrsquo box These factors are not a key focus for selection of projects for
INNOSERV as they are often very situation specific but will be noted in the case
studies where relevant The factors which prompt or trigger specific innovations
whether socially based or otherwise are not are not mutually exclusive (Bason
2010) and in there is a complex and interacting relationship between a variety of
factors for any given innovation lsquoinstancersquo In addition there are well documented
factors which act to inhibit the development of innovative responses (see Crepaldi
et al 201215)
This work package has sought to identify generic criteria and drivers but it must be
recognised that the dynamics of individual settings and local factors will impact on
the actual processes of adoption
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
24
6 Conclusions and next steps
This report has presented the framework which has been used within the INNOSERV
project to support the choice of innovative case studies and to assist in identifying
the innovation phenomena potential and processes important to future research in
this area The framework has been used to select projects as case studies (see Work
Package 4 report Eurich and Strifler 2012) The framework interlinks aspects of
innovation (novelty type context improvement sustainability) with analysis of
challenges and changes which are acting as driving forces of innovation in social
services As the project is future facing it is proposed that key social challenges
and changes are likely to inform the development of new change paradigms for the
delivery of social services across Europe The framework will inform further
development and testing of concepts through the next stages of the INNOSERVE
programme This process will result in descriptions for the key areas in which future
research on innovation in social services should be taken forward
25
7 Bibliography
Bason C (2010) Leading public sector innovation Co-creating for a better society
Bristol The Policy Press
Bereiter C (2002) Design research for sustained innovation Cognitive Studies
Bulletin of the Japanese Cognitive Society 9 321-327
Christensen CM and Overdorf M (2000) Meeting the Challenge of Disruptive
Change Harvard Business Review March-April
Clark M and Goodwin N (2010) Sustaining innovation in telehealth and telecare
WSDNA briefing paper London The Kings Fund
Crepaldi C De Rosa E And Pesce F (2012) Literature review on innovation in
social services in Europe (sectors of Health Education and Welfare
Services)INNOSERV Work Package 1 report
Department of Health (2011) Innovation Health and Wealth Accelerating Adoption
and Diffusion in the NHS London Department of Health
Eurich J and Strifler A (2012) European compared selection of innovative social
services INNOSERV Work Package 4 report
Fuglsang L (2010) Bricolage and invisible innovation in public service innovation
Journal of Innovation Economics 5 67-87
Greenhalgh T Robert G Macfarlane F Bate P Kyriakidou O (2004) Diffusion of
innovations in service organizations systematic review and recommendations
Milbank Quarterly 82581-629
Hartley J (2005) Innovation in Governance and Public Services Past and Present
Public Money and Management 25127-34
Koch P and Hauknes J (2005) On innovation in the Public Sector Publin report no
D20
Kuhn T (1962) The Structure of Scientific Revolutions Chicago The University of
Chicago Press
Lakatos I and Musgrave A (eds) (1970) Criticism and the growth of knowledge
London Cambridge University Press
May
C Finch T Mair F et al ( 2007) Understanding the implementation of
complex interventions in health care the normalization process model BMC Health
Services Research 2007 7148 doi1011861472-6963-7-148
May et al (2009) Implementing Embedding and Integrating Practices An Outline of
Normalization Process Theory Sociology 43 535-554
Murray R Caulier-Grice J and Mulgan G (2010) The Open Book of Social
Innovation London The Young Foundation
26
OECD (2005) Oslo manual Guidelines for collecting and interpreting innovation
data 3rd
edition
Oliver M (1990) The politics of disablement Basingstoke Macmillan Education Ltd
Osborne S (1998) Naming the Beast Defining and Classifying Service Innovations
in Social Policy Human Relations 51 9 1133-1154
Osborne S and Brown K (2005) Managing Change and Innovation in Public Service
Organizations London Routledge
Phills JA Deiglmeier K and Miller DT (2008) Rediscovering Social Innovation
Stamford Innovation Review 6 4 34-43
Sullivan M (1987) Sociology and Social Welfare London Allen and Unwin
Tidd J and Bessant J (2009) Managing Innovation Integrating Technological
Market and organizational Change 4th
edition Chichester John Wiley and Sons
UK Government Department of Health (2011) Innovation Health and Wealth
Accelerating adoption and diffusion in the NHS London Department of Health
Wolfensburger W (1975) The principle of normalisation in human services Toronto
National Institute on Mental Retardation
27
8 Appendices
Appendix 1 Summary of types and criteria of innovation used in Work Package
3 to identify practices
Identification of social service
Field(s) of service
Logic(s) of service
Self help or mutual aid logic Social care logic Multi-stakeholders logic Social
movements logic Combination
Activities of services delivered
Assistance for persons faced with personal challenges or crises (debt unemployment
drug addiction other) (Re)integration of persons into society (rehabilitation language
training for immigrants other) Services to the labour market (occupational training)
Social housing for disadvantaged groups Care (for the elderly children families )
Treatment and support of people with physical illnesses Treatment and support of
people with mental health problems Combination
Status of the provider organization
Public organization (governmental) Private organization ndash nonnot for profit Private
organization ndash profit Volunteer association Cooperative company or mutual company
Familyneighbourhood Civil society network Combination Other
Target group
Children Youngsters Elder people Unemployed people Poor people Immigrants
Disabled people People with chronic diseases ndash long-term health problems People with
acute or short term health problems No specific target group (eg territory-based social
services provision aiming at strengthen social ties) Combination Other
Size of the organization
Innovation
Type of innovation
New forms of organization resources hybridization new targeted actions new services
non-structural practices other
Innovative character
do the service practices appear to be something new in the field of social services
Origins of innovation
Supply side demand side broader operating factors
Impact on service performance
Effectiveness of service delivery
from user perspective cost effectivenesscapacity building sustainability of
innovation
Quality of provision
28
Socialization quality of life as judged by users and beneficiaries more inclusion
lower risk on exclusion participation of the user transition from institutional to
community based care
Potential wider effects
Promoting social and health equality sustainability new skills and jobs
increased social rights affordability of adequate and high quality health and long-
term care promotion of equality and non-discrimination equal access to adequate
provision
Transferability of innovations between national contexts
29
Appendix 2 levels of innovation identified within INNOSERV Work Package 2
literature review
Organizational level (policy organizational sectors)
New social services designed to face new needs or unmet needs
Search for new solutions to old needs new mechanisms or practices introduced in
preexisting
social services
to improve access to social services (ie more information increased
professionalism in
social work sector)
to guarantee entitlements (rights) for specific groups or minorities
to satisfy the demand for social services in a more complete and broad way
(holistic
approach)
to guarantee more participation and inclusion of citizens
New and increased Cross-Sectoral social services
Cross-Sectoral social services (ie teaching art to children while helping their mothers
for
job seeking and offering jobs for young artists)
Integrated care practices
Tearing down walls between sectors and the role of informal care
Sharing of knowledge
Better integration of Health and Social sector services
Territory based social services that contribute to the creation of training and job
opportunities for disadvantaged people
Solidarity-based social services
Social mediation for impaired and weakened people
Easy access to housing for poor families
New interfaces with clients
Logic(s) of service Self help or mutual aid logic Social care logic Multi-stakeholders
logic
Social movements logic
The development of the self-help sector
Actors New organizations (Cooperative society for social service provision ndashSCOP
Cooperative society as social enterprise with userrsquos involvement ndashSCIC)
New legal forms within structured public frameworks (Italy social cooperatives)
New provider organizations and existing organisations refashioned by new dynamics
New roles and relations among actors
New private organizations for profit and non-profit
Management style in the organization
Regulatory and legislative level
New architecture of the provision system
Socially responsible public contracts and social clauses (outsourcing)
Adherence to EU standards in transitional economies
Impact on institutional framework that shape innovation in social services
New arrangement between one or more government agencies andor external
organization
Organizational level ndash Connection and Cooperation (governance and partnership)
New networks and social movements established in order to design deliver and
finance
social services
Cooperation between sectors actors and different forms of provision
Cooperation between local actors
Increasing communication responsiveness
30
Utilizing connectivity and interdependencies
Modification of organizational systems (models of governance work organisation
number
of involved stakeholders in governance)
Public sector and local authorities as promoters of innovation and promoters of
crosssectoral
policy strategies
Third sector and user as promoters of innovation
Volunteer workers and initiatives launched by a group of citizens
Third sector and userrsquos engagement design (co-design and re-design services)
Joint decision process
Decision-making power not based on capital ownership
Employee and user driven innovation
Partnerships with users family carers and user organizations
Partnership between service users practitioners and academics
Community-based and participative health network in a local territory
Collaboration between public and volunteer organisations (NGOs) or between civil and
local
networks in collaboration with public organisations and social enterprises
New techniques for partnership building and functioning
Impact on social and power relations
Professional level (practitioners)
New practices in social work
Innovative tools (ie Theatre of the Oppressed) and the use of participated methods in
social
work (ie self-help group)
Networking
Individualised supports
New professional skills in social work
The use of informatics and new technologies in social work
Users
Participation and involvement of final users of services in designing delivering and
evaluating social services
Involvement of final users in promoting equality effectiveness and control and
adherence
to the needs of users
Conceptual Level (and value)
New models of society - Social goals participation user involvement community
benefit
New paradigms underlying a new social service concept or service delivery model (ie
new
inclusion paradigm active ageing)
Relationships and trust
Pursuing diversity
Better adjustment to usersrsquo needs more person centred support
More social services provision in less developed regions
New concept of accessibility of the service (ie for Roma families)
The concept of lsquoprogressive universalismrsquo
The Social Care Model
De-institutionalization and community care Improved home-based and community
services
Gender and diversity perspectives
Anti-discrimination and equality process
Increase of the level of recognition of social values objectives paradigms and goals
New models of interaction leading to social innovation processes
31
Public policy level (policy framework programs and social policies)
The new role of the system governance played by central (or local depending on
national
arrangements) government
Impact on public policies new public policy programme measure or intervention
Joint construction of a space for public action and redefinition of public governance
bodies
and methods
Innovative logics for public policies
Innovating the public sector
The new wide attention on anti stigma policies
E-government
Financial and economic sustainability level (and scaling-diffusion-transferability
of innovation)
New ways to overcome budgetary constraints
New approaches to acquire funding
The involvement of private investors
The introduction of special funds
The purchase of innovative practices by final users
Hybridization of resources (market redistribution and reciprocity resources)
New investment sources
Mobilising community resources taking full advantage of all endogenous resources
Improvement in efficiency and effectiveness
Financial and systemic sustainability Impact on the economy
Economic Environmental and Social Sustainability of Territory based social services
Financial tools necessary to territorial social initiatives and the way to unlock them
Capacity of spreading and diffusion
Evaluative level and attention for quality
Affordability availability and accessibility
New standards expected
New feedback loops from users and specialists
Social services of excellence as for quality efficiency and efficacy
New methods and creative tool-kits to strengthen and renew the quality of social care
services
Low-cost (for user) and high level quality of social services
Quality assurance moderation and accreditation mechanisms
New tools for monitoring social services - hearing all voices (users organizations
practioners staff family and friends)
Action research
Alternative economic and social indicators
Social impact and contribution of innovation in social services to social innovation and
social change ndash Assessment of innovation
Learning approach to evaluation ndash lsquoto learn from failuresrsquo
Developmental evaluation
Specifics for the Health sector
Disability from rehabilitation to integration and then to inclusion
Mental Health from segregation to inclusion and community care
HIV from segregationstigmatization to awareness campaigns for promoting self
protection
Innovation in the area of prevention of treatment and in the introduction of new
technologies
Emphasis on an inter-sectoral controlled and steered care in managed care models
replacement of the traditional insurance model
Integrated services
Technological progress
32
Specifics for the Education sector
Inclusive education
Inclusive education and training in collaboration with the civil society
Multicultural education
Integration of disciplines
Alternative schools non-regular schools and informal education
Link between formal and informal education
Community development based approaches
Connection between regular school and the system of social services
Experiential learning
Human rights education
Working lsquothrough relationshipsrsquo with children and young people
Problem based learning methodology
The lsquomedia educationrsquo The use of comics
ICT in schools
E-inclusion
Networks of schools
Improve supplement reinvent and transform learning
Sustained educational improvement
Learning Beyond the Classroom
Spreading a culture that values learning
More personalized approaches to learning
Using the web
Learning with and by not to and from
33
Appendix 3 analysis of social challenges and changes driving innovation
Welfare
Societal
change as
driving force
of innovation
in social
services
Meaning
description
Related
outcomesother
factors
Examples of innovative
responses
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
Empowerment self-
determination choice
The lsquoassertive userrsquo
Demand for more
individualised services of
better quality
Alternativecomplementary
providers
Personalisation
Co-production (new
userprofessional
relationships)
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demand on services
Potential for poor access
to services (from
communication
problems social
isolation)
Multiculturalism
Integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Declining female
caregiving
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
34
Increased demand for
services demand for
formal care
Continued
inequality
Continued
economic
inequality
unemployment
continued poverty
including child
poverty continued
institutionalisation
continued
inequality for
people with
disabilities ethnic
minorities gender
inequalities
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients
with complex
comorbidities increase
in certain diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing demand for
services Increasing
costsneed to make
limited resources go
further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
Decisions about value
marketization
Technological
development
Access to
information new
media technology
Facilitates self
determination increases
expectations and choice
population better
informed about
conditionsservicesright
s and less deferential
Users better able to
35
mobilise
Increased exclusion of
some groups with limited
access
New models of remote
care provision
Ability to exchange
information on quality
and experience
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Increasing costs
Decisions about value
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Organisational
change changing
management
styles
philosophies
Creating new
organisational
forms application
of more responsive
management
processes
performance
management
culture
Integration of
organisationsfunctions
new approaches to
lsquocommissioningrsquo of
organisationsservices
distortions caused by
lsquolocked inrsquo expenditures
(tertiary health care
residential care)
Decentralisation
deinstitutionalisation
marketization liberalisation
The lsquoenabling
statersquo Political
will fiscal space
Impact of financial
crisis competing
priorities for public
funds
Legacy of category-based
(not needs based) social
protection structural
transition
deindustrialisation
Health
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
EmpowermentSelf-
determination choice
Demand for more
individualised services of
better quality
Users better able to mobilise
Assertive lsquouserrsquo
knowledgeable patient
Alternativecomplimentary
providers
36
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demands on
services
Potential for poor access
to services (from
communication
problems social
isolation)
MulticulturalismTrained
health professionals
move to richer countries
integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Declining female
caregiving
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
Increased demand for
formal care services
Continued
inequalities
Unequal
distribution of
health risks and
health
outcomediseases
by socioeconomic
indicators
Unequal access to
care by social
status geography
gender and
ethnicity
Demographic Increase in
numbers of over
Increase in patients with
complex comorbidities
Increasing demand for care
Decisions about value Active
37
change 65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing costsneed to
make limited resources
go further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
ageing paradigm
Technological
development
Access to
information new
media technology
Self determination
expectations choice
population better
informed about
conditionsservicesright
s and less deferential
Ability to exchange
information on quality
and experience
New models of care provision
(eg telehealth care) new
health management systems
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Changing
management
stylesphilosophi
es
Application of
more responsive
management
processes
Decentralisation
deinstitutionalisation
marketization liberalisation
Lifestyle changes Increase in certain
diseases related to
obesity alcohol
and drug
Increasing
costsdemands for care
38
consumption and
stress diabetes
liver disease
anxiety and
depression
Education
Aspirations Rising expectations
by citizens for
better quality of
life
Self determination
choice consumerism
Education outside of formal
setting
Assertive user
Lifelong learningeducation
Migration Historical (post
colonial) migration
pan-EU migration
refugees
New needs for education
eg language and culture
Inequalities social
fragmentation
Social Roles Changing family
structure increase
in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
changing gender
roles rising
female
employment rates
Need to reconcile work
and family life
Parentingfamily skills
for vulnerable
parentsfamilies
Socialization of children
ndash social and emotional
deficits for children in
some environments
Work with families and
communities
Continued
inequalities
Inequality in
educational
accessattainment
by socioeconomic
status gender
people with
disabilities ethnic
minorities
Culture of failure
Promise to deliver social
mobility and economic
improvement
(Leadbeater and Wond
2010 pp 5-20)
Inclusive and multicultural
education
Differential support for
children from
lsquodisadvantagedrsquo
backgrounds
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients with
complex comorbidities
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
New group of older
39
learners
Technological
advance
Access to
information new
media technology
making learning
available in new
ways
Self determination
expectations choice
lsquoAssertive userrsquo
Increased exclusion of
some groups with limited
access
Changing
management
styles
philosophies
Community based models
Globalization Need to provide
educationtraining
which is suited to
modern knowledge
based global
economies
This report for the InnoServ project (grant agreement nr 290542) is supported
under the Socio-economic and Humanities Programme of FP7
Chris Hawker
Faculty of Health Sciences University of Southampton Building 67 University Road Highfield Campus Southampton SO17 1BJ
Tel +44 (0)23 8059 7968
Email CHawkersotonacuk
22
very emergence of conflicts lsquoExternalrsquo interventions often do not reach every day
interaction and thus the root causes of problems This is of significance for family
based projects as well as for care institutions and education providers
48 Organisational changes as a key societal change driving innovation in
welfare service sectors
The shifting of provision of services from the public sector into other sectors such
as independent profit making companies and social enterprises creates new
opportunities for innovation In addition there is an increasing move to provide
services locally in order to be more relevant and responsive and a move to
community based models of care
49 Changing management styles as a key innovation challenge for the
education service sector and in cross sector services of the health and
education sector
Connected to individualism as well as new social roles of individuals family
community and institutions management styles shaped by multi-stakeholder
involvement are gaining importance Community based models do not only increase
the complexity of players involved in the lsquovalue creationrsquo process but also the
enhancement of skill development and personality formation as well as the
fertilization of the educational landscape by innovative ideas expertise and
practices of diverse partners The latter fact also stimulates an increase in cross-
sectoral services (education health and social services) Simultaneously this
situation increases the necessity to spot choose and foster the lsquoinfluencesrsquo and
lsquocombinationsrsquo which realize the highest value through the assessment of social
impact
Increased emphasis is also being placed on illustrating and monitoring
performance Impact measurement and associated tools and practices gain
overarching importance
In terms of changing management styles within the health and education sector an
important aspect is the cooperation of different stakeholders and the involvement
of the community or userrsquos perspective Linked to increased user aspirations
people would like to take part in the development of programs and services With
their special knowledge of their condition for example they can contribute their
expertise within social services
23
5 Other key challenges driving innovation
Sociatal challenges and changes are of course only one driving force of innovation
In addition to these there are other meso and micro level factors which also drive
innovation These include research and development leading to new knowledge
professionally led innovation in response to users needs increasing costs of service
provision and demands for greater efficiency per se and specific political contexts
These other forces are included in the INNOSERV criteria framework in the
lsquochallengesrsquo box These factors are not a key focus for selection of projects for
INNOSERV as they are often very situation specific but will be noted in the case
studies where relevant The factors which prompt or trigger specific innovations
whether socially based or otherwise are not are not mutually exclusive (Bason
2010) and in there is a complex and interacting relationship between a variety of
factors for any given innovation lsquoinstancersquo In addition there are well documented
factors which act to inhibit the development of innovative responses (see Crepaldi
et al 201215)
This work package has sought to identify generic criteria and drivers but it must be
recognised that the dynamics of individual settings and local factors will impact on
the actual processes of adoption
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
24
6 Conclusions and next steps
This report has presented the framework which has been used within the INNOSERV
project to support the choice of innovative case studies and to assist in identifying
the innovation phenomena potential and processes important to future research in
this area The framework has been used to select projects as case studies (see Work
Package 4 report Eurich and Strifler 2012) The framework interlinks aspects of
innovation (novelty type context improvement sustainability) with analysis of
challenges and changes which are acting as driving forces of innovation in social
services As the project is future facing it is proposed that key social challenges
and changes are likely to inform the development of new change paradigms for the
delivery of social services across Europe The framework will inform further
development and testing of concepts through the next stages of the INNOSERVE
programme This process will result in descriptions for the key areas in which future
research on innovation in social services should be taken forward
25
7 Bibliography
Bason C (2010) Leading public sector innovation Co-creating for a better society
Bristol The Policy Press
Bereiter C (2002) Design research for sustained innovation Cognitive Studies
Bulletin of the Japanese Cognitive Society 9 321-327
Christensen CM and Overdorf M (2000) Meeting the Challenge of Disruptive
Change Harvard Business Review March-April
Clark M and Goodwin N (2010) Sustaining innovation in telehealth and telecare
WSDNA briefing paper London The Kings Fund
Crepaldi C De Rosa E And Pesce F (2012) Literature review on innovation in
social services in Europe (sectors of Health Education and Welfare
Services)INNOSERV Work Package 1 report
Department of Health (2011) Innovation Health and Wealth Accelerating Adoption
and Diffusion in the NHS London Department of Health
Eurich J and Strifler A (2012) European compared selection of innovative social
services INNOSERV Work Package 4 report
Fuglsang L (2010) Bricolage and invisible innovation in public service innovation
Journal of Innovation Economics 5 67-87
Greenhalgh T Robert G Macfarlane F Bate P Kyriakidou O (2004) Diffusion of
innovations in service organizations systematic review and recommendations
Milbank Quarterly 82581-629
Hartley J (2005) Innovation in Governance and Public Services Past and Present
Public Money and Management 25127-34
Koch P and Hauknes J (2005) On innovation in the Public Sector Publin report no
D20
Kuhn T (1962) The Structure of Scientific Revolutions Chicago The University of
Chicago Press
Lakatos I and Musgrave A (eds) (1970) Criticism and the growth of knowledge
London Cambridge University Press
May
C Finch T Mair F et al ( 2007) Understanding the implementation of
complex interventions in health care the normalization process model BMC Health
Services Research 2007 7148 doi1011861472-6963-7-148
May et al (2009) Implementing Embedding and Integrating Practices An Outline of
Normalization Process Theory Sociology 43 535-554
Murray R Caulier-Grice J and Mulgan G (2010) The Open Book of Social
Innovation London The Young Foundation
26
OECD (2005) Oslo manual Guidelines for collecting and interpreting innovation
data 3rd
edition
Oliver M (1990) The politics of disablement Basingstoke Macmillan Education Ltd
Osborne S (1998) Naming the Beast Defining and Classifying Service Innovations
in Social Policy Human Relations 51 9 1133-1154
Osborne S and Brown K (2005) Managing Change and Innovation in Public Service
Organizations London Routledge
Phills JA Deiglmeier K and Miller DT (2008) Rediscovering Social Innovation
Stamford Innovation Review 6 4 34-43
Sullivan M (1987) Sociology and Social Welfare London Allen and Unwin
Tidd J and Bessant J (2009) Managing Innovation Integrating Technological
Market and organizational Change 4th
edition Chichester John Wiley and Sons
UK Government Department of Health (2011) Innovation Health and Wealth
Accelerating adoption and diffusion in the NHS London Department of Health
Wolfensburger W (1975) The principle of normalisation in human services Toronto
National Institute on Mental Retardation
27
8 Appendices
Appendix 1 Summary of types and criteria of innovation used in Work Package
3 to identify practices
Identification of social service
Field(s) of service
Logic(s) of service
Self help or mutual aid logic Social care logic Multi-stakeholders logic Social
movements logic Combination
Activities of services delivered
Assistance for persons faced with personal challenges or crises (debt unemployment
drug addiction other) (Re)integration of persons into society (rehabilitation language
training for immigrants other) Services to the labour market (occupational training)
Social housing for disadvantaged groups Care (for the elderly children families )
Treatment and support of people with physical illnesses Treatment and support of
people with mental health problems Combination
Status of the provider organization
Public organization (governmental) Private organization ndash nonnot for profit Private
organization ndash profit Volunteer association Cooperative company or mutual company
Familyneighbourhood Civil society network Combination Other
Target group
Children Youngsters Elder people Unemployed people Poor people Immigrants
Disabled people People with chronic diseases ndash long-term health problems People with
acute or short term health problems No specific target group (eg territory-based social
services provision aiming at strengthen social ties) Combination Other
Size of the organization
Innovation
Type of innovation
New forms of organization resources hybridization new targeted actions new services
non-structural practices other
Innovative character
do the service practices appear to be something new in the field of social services
Origins of innovation
Supply side demand side broader operating factors
Impact on service performance
Effectiveness of service delivery
from user perspective cost effectivenesscapacity building sustainability of
innovation
Quality of provision
28
Socialization quality of life as judged by users and beneficiaries more inclusion
lower risk on exclusion participation of the user transition from institutional to
community based care
Potential wider effects
Promoting social and health equality sustainability new skills and jobs
increased social rights affordability of adequate and high quality health and long-
term care promotion of equality and non-discrimination equal access to adequate
provision
Transferability of innovations between national contexts
29
Appendix 2 levels of innovation identified within INNOSERV Work Package 2
literature review
Organizational level (policy organizational sectors)
New social services designed to face new needs or unmet needs
Search for new solutions to old needs new mechanisms or practices introduced in
preexisting
social services
to improve access to social services (ie more information increased
professionalism in
social work sector)
to guarantee entitlements (rights) for specific groups or minorities
to satisfy the demand for social services in a more complete and broad way
(holistic
approach)
to guarantee more participation and inclusion of citizens
New and increased Cross-Sectoral social services
Cross-Sectoral social services (ie teaching art to children while helping their mothers
for
job seeking and offering jobs for young artists)
Integrated care practices
Tearing down walls between sectors and the role of informal care
Sharing of knowledge
Better integration of Health and Social sector services
Territory based social services that contribute to the creation of training and job
opportunities for disadvantaged people
Solidarity-based social services
Social mediation for impaired and weakened people
Easy access to housing for poor families
New interfaces with clients
Logic(s) of service Self help or mutual aid logic Social care logic Multi-stakeholders
logic
Social movements logic
The development of the self-help sector
Actors New organizations (Cooperative society for social service provision ndashSCOP
Cooperative society as social enterprise with userrsquos involvement ndashSCIC)
New legal forms within structured public frameworks (Italy social cooperatives)
New provider organizations and existing organisations refashioned by new dynamics
New roles and relations among actors
New private organizations for profit and non-profit
Management style in the organization
Regulatory and legislative level
New architecture of the provision system
Socially responsible public contracts and social clauses (outsourcing)
Adherence to EU standards in transitional economies
Impact on institutional framework that shape innovation in social services
New arrangement between one or more government agencies andor external
organization
Organizational level ndash Connection and Cooperation (governance and partnership)
New networks and social movements established in order to design deliver and
finance
social services
Cooperation between sectors actors and different forms of provision
Cooperation between local actors
Increasing communication responsiveness
30
Utilizing connectivity and interdependencies
Modification of organizational systems (models of governance work organisation
number
of involved stakeholders in governance)
Public sector and local authorities as promoters of innovation and promoters of
crosssectoral
policy strategies
Third sector and user as promoters of innovation
Volunteer workers and initiatives launched by a group of citizens
Third sector and userrsquos engagement design (co-design and re-design services)
Joint decision process
Decision-making power not based on capital ownership
Employee and user driven innovation
Partnerships with users family carers and user organizations
Partnership between service users practitioners and academics
Community-based and participative health network in a local territory
Collaboration between public and volunteer organisations (NGOs) or between civil and
local
networks in collaboration with public organisations and social enterprises
New techniques for partnership building and functioning
Impact on social and power relations
Professional level (practitioners)
New practices in social work
Innovative tools (ie Theatre of the Oppressed) and the use of participated methods in
social
work (ie self-help group)
Networking
Individualised supports
New professional skills in social work
The use of informatics and new technologies in social work
Users
Participation and involvement of final users of services in designing delivering and
evaluating social services
Involvement of final users in promoting equality effectiveness and control and
adherence
to the needs of users
Conceptual Level (and value)
New models of society - Social goals participation user involvement community
benefit
New paradigms underlying a new social service concept or service delivery model (ie
new
inclusion paradigm active ageing)
Relationships and trust
Pursuing diversity
Better adjustment to usersrsquo needs more person centred support
More social services provision in less developed regions
New concept of accessibility of the service (ie for Roma families)
The concept of lsquoprogressive universalismrsquo
The Social Care Model
De-institutionalization and community care Improved home-based and community
services
Gender and diversity perspectives
Anti-discrimination and equality process
Increase of the level of recognition of social values objectives paradigms and goals
New models of interaction leading to social innovation processes
31
Public policy level (policy framework programs and social policies)
The new role of the system governance played by central (or local depending on
national
arrangements) government
Impact on public policies new public policy programme measure or intervention
Joint construction of a space for public action and redefinition of public governance
bodies
and methods
Innovative logics for public policies
Innovating the public sector
The new wide attention on anti stigma policies
E-government
Financial and economic sustainability level (and scaling-diffusion-transferability
of innovation)
New ways to overcome budgetary constraints
New approaches to acquire funding
The involvement of private investors
The introduction of special funds
The purchase of innovative practices by final users
Hybridization of resources (market redistribution and reciprocity resources)
New investment sources
Mobilising community resources taking full advantage of all endogenous resources
Improvement in efficiency and effectiveness
Financial and systemic sustainability Impact on the economy
Economic Environmental and Social Sustainability of Territory based social services
Financial tools necessary to territorial social initiatives and the way to unlock them
Capacity of spreading and diffusion
Evaluative level and attention for quality
Affordability availability and accessibility
New standards expected
New feedback loops from users and specialists
Social services of excellence as for quality efficiency and efficacy
New methods and creative tool-kits to strengthen and renew the quality of social care
services
Low-cost (for user) and high level quality of social services
Quality assurance moderation and accreditation mechanisms
New tools for monitoring social services - hearing all voices (users organizations
practioners staff family and friends)
Action research
Alternative economic and social indicators
Social impact and contribution of innovation in social services to social innovation and
social change ndash Assessment of innovation
Learning approach to evaluation ndash lsquoto learn from failuresrsquo
Developmental evaluation
Specifics for the Health sector
Disability from rehabilitation to integration and then to inclusion
Mental Health from segregation to inclusion and community care
HIV from segregationstigmatization to awareness campaigns for promoting self
protection
Innovation in the area of prevention of treatment and in the introduction of new
technologies
Emphasis on an inter-sectoral controlled and steered care in managed care models
replacement of the traditional insurance model
Integrated services
Technological progress
32
Specifics for the Education sector
Inclusive education
Inclusive education and training in collaboration with the civil society
Multicultural education
Integration of disciplines
Alternative schools non-regular schools and informal education
Link between formal and informal education
Community development based approaches
Connection between regular school and the system of social services
Experiential learning
Human rights education
Working lsquothrough relationshipsrsquo with children and young people
Problem based learning methodology
The lsquomedia educationrsquo The use of comics
ICT in schools
E-inclusion
Networks of schools
Improve supplement reinvent and transform learning
Sustained educational improvement
Learning Beyond the Classroom
Spreading a culture that values learning
More personalized approaches to learning
Using the web
Learning with and by not to and from
33
Appendix 3 analysis of social challenges and changes driving innovation
Welfare
Societal
change as
driving force
of innovation
in social
services
Meaning
description
Related
outcomesother
factors
Examples of innovative
responses
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
Empowerment self-
determination choice
The lsquoassertive userrsquo
Demand for more
individualised services of
better quality
Alternativecomplementary
providers
Personalisation
Co-production (new
userprofessional
relationships)
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demand on services
Potential for poor access
to services (from
communication
problems social
isolation)
Multiculturalism
Integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Declining female
caregiving
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
34
Increased demand for
services demand for
formal care
Continued
inequality
Continued
economic
inequality
unemployment
continued poverty
including child
poverty continued
institutionalisation
continued
inequality for
people with
disabilities ethnic
minorities gender
inequalities
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients
with complex
comorbidities increase
in certain diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing demand for
services Increasing
costsneed to make
limited resources go
further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
Decisions about value
marketization
Technological
development
Access to
information new
media technology
Facilitates self
determination increases
expectations and choice
population better
informed about
conditionsservicesright
s and less deferential
Users better able to
35
mobilise
Increased exclusion of
some groups with limited
access
New models of remote
care provision
Ability to exchange
information on quality
and experience
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Increasing costs
Decisions about value
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Organisational
change changing
management
styles
philosophies
Creating new
organisational
forms application
of more responsive
management
processes
performance
management
culture
Integration of
organisationsfunctions
new approaches to
lsquocommissioningrsquo of
organisationsservices
distortions caused by
lsquolocked inrsquo expenditures
(tertiary health care
residential care)
Decentralisation
deinstitutionalisation
marketization liberalisation
The lsquoenabling
statersquo Political
will fiscal space
Impact of financial
crisis competing
priorities for public
funds
Legacy of category-based
(not needs based) social
protection structural
transition
deindustrialisation
Health
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
EmpowermentSelf-
determination choice
Demand for more
individualised services of
better quality
Users better able to mobilise
Assertive lsquouserrsquo
knowledgeable patient
Alternativecomplimentary
providers
36
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demands on
services
Potential for poor access
to services (from
communication
problems social
isolation)
MulticulturalismTrained
health professionals
move to richer countries
integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Declining female
caregiving
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
Increased demand for
formal care services
Continued
inequalities
Unequal
distribution of
health risks and
health
outcomediseases
by socioeconomic
indicators
Unequal access to
care by social
status geography
gender and
ethnicity
Demographic Increase in
numbers of over
Increase in patients with
complex comorbidities
Increasing demand for care
Decisions about value Active
37
change 65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing costsneed to
make limited resources
go further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
ageing paradigm
Technological
development
Access to
information new
media technology
Self determination
expectations choice
population better
informed about
conditionsservicesright
s and less deferential
Ability to exchange
information on quality
and experience
New models of care provision
(eg telehealth care) new
health management systems
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Changing
management
stylesphilosophi
es
Application of
more responsive
management
processes
Decentralisation
deinstitutionalisation
marketization liberalisation
Lifestyle changes Increase in certain
diseases related to
obesity alcohol
and drug
Increasing
costsdemands for care
38
consumption and
stress diabetes
liver disease
anxiety and
depression
Education
Aspirations Rising expectations
by citizens for
better quality of
life
Self determination
choice consumerism
Education outside of formal
setting
Assertive user
Lifelong learningeducation
Migration Historical (post
colonial) migration
pan-EU migration
refugees
New needs for education
eg language and culture
Inequalities social
fragmentation
Social Roles Changing family
structure increase
in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
changing gender
roles rising
female
employment rates
Need to reconcile work
and family life
Parentingfamily skills
for vulnerable
parentsfamilies
Socialization of children
ndash social and emotional
deficits for children in
some environments
Work with families and
communities
Continued
inequalities
Inequality in
educational
accessattainment
by socioeconomic
status gender
people with
disabilities ethnic
minorities
Culture of failure
Promise to deliver social
mobility and economic
improvement
(Leadbeater and Wond
2010 pp 5-20)
Inclusive and multicultural
education
Differential support for
children from
lsquodisadvantagedrsquo
backgrounds
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients with
complex comorbidities
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
New group of older
39
learners
Technological
advance
Access to
information new
media technology
making learning
available in new
ways
Self determination
expectations choice
lsquoAssertive userrsquo
Increased exclusion of
some groups with limited
access
Changing
management
styles
philosophies
Community based models
Globalization Need to provide
educationtraining
which is suited to
modern knowledge
based global
economies
This report for the InnoServ project (grant agreement nr 290542) is supported
under the Socio-economic and Humanities Programme of FP7
Chris Hawker
Faculty of Health Sciences University of Southampton Building 67 University Road Highfield Campus Southampton SO17 1BJ
Tel +44 (0)23 8059 7968
Email CHawkersotonacuk
23
5 Other key challenges driving innovation
Sociatal challenges and changes are of course only one driving force of innovation
In addition to these there are other meso and micro level factors which also drive
innovation These include research and development leading to new knowledge
professionally led innovation in response to users needs increasing costs of service
provision and demands for greater efficiency per se and specific political contexts
These other forces are included in the INNOSERV criteria framework in the
lsquochallengesrsquo box These factors are not a key focus for selection of projects for
INNOSERV as they are often very situation specific but will be noted in the case
studies where relevant The factors which prompt or trigger specific innovations
whether socially based or otherwise are not are not mutually exclusive (Bason
2010) and in there is a complex and interacting relationship between a variety of
factors for any given innovation lsquoinstancersquo In addition there are well documented
factors which act to inhibit the development of innovative responses (see Crepaldi
et al 201215)
This work package has sought to identify generic criteria and drivers but it must be
recognised that the dynamics of individual settings and local factors will impact on
the actual processes of adoption
Drivers
Demographic
change
Social change
Technological
change
Challenges
New needs
Higher Costs
Response
New service
New form of delivery
New form of
governance
New form of
resourcing
New way of
evaluation
Hallmarks of
innovation
Contextual fit
Improve
quality
Sustainable
Novelty
New
perspectives
on old needs
New practices
for old needs
New practices
for new needs
24
6 Conclusions and next steps
This report has presented the framework which has been used within the INNOSERV
project to support the choice of innovative case studies and to assist in identifying
the innovation phenomena potential and processes important to future research in
this area The framework has been used to select projects as case studies (see Work
Package 4 report Eurich and Strifler 2012) The framework interlinks aspects of
innovation (novelty type context improvement sustainability) with analysis of
challenges and changes which are acting as driving forces of innovation in social
services As the project is future facing it is proposed that key social challenges
and changes are likely to inform the development of new change paradigms for the
delivery of social services across Europe The framework will inform further
development and testing of concepts through the next stages of the INNOSERVE
programme This process will result in descriptions for the key areas in which future
research on innovation in social services should be taken forward
25
7 Bibliography
Bason C (2010) Leading public sector innovation Co-creating for a better society
Bristol The Policy Press
Bereiter C (2002) Design research for sustained innovation Cognitive Studies
Bulletin of the Japanese Cognitive Society 9 321-327
Christensen CM and Overdorf M (2000) Meeting the Challenge of Disruptive
Change Harvard Business Review March-April
Clark M and Goodwin N (2010) Sustaining innovation in telehealth and telecare
WSDNA briefing paper London The Kings Fund
Crepaldi C De Rosa E And Pesce F (2012) Literature review on innovation in
social services in Europe (sectors of Health Education and Welfare
Services)INNOSERV Work Package 1 report
Department of Health (2011) Innovation Health and Wealth Accelerating Adoption
and Diffusion in the NHS London Department of Health
Eurich J and Strifler A (2012) European compared selection of innovative social
services INNOSERV Work Package 4 report
Fuglsang L (2010) Bricolage and invisible innovation in public service innovation
Journal of Innovation Economics 5 67-87
Greenhalgh T Robert G Macfarlane F Bate P Kyriakidou O (2004) Diffusion of
innovations in service organizations systematic review and recommendations
Milbank Quarterly 82581-629
Hartley J (2005) Innovation in Governance and Public Services Past and Present
Public Money and Management 25127-34
Koch P and Hauknes J (2005) On innovation in the Public Sector Publin report no
D20
Kuhn T (1962) The Structure of Scientific Revolutions Chicago The University of
Chicago Press
Lakatos I and Musgrave A (eds) (1970) Criticism and the growth of knowledge
London Cambridge University Press
May
C Finch T Mair F et al ( 2007) Understanding the implementation of
complex interventions in health care the normalization process model BMC Health
Services Research 2007 7148 doi1011861472-6963-7-148
May et al (2009) Implementing Embedding and Integrating Practices An Outline of
Normalization Process Theory Sociology 43 535-554
Murray R Caulier-Grice J and Mulgan G (2010) The Open Book of Social
Innovation London The Young Foundation
26
OECD (2005) Oslo manual Guidelines for collecting and interpreting innovation
data 3rd
edition
Oliver M (1990) The politics of disablement Basingstoke Macmillan Education Ltd
Osborne S (1998) Naming the Beast Defining and Classifying Service Innovations
in Social Policy Human Relations 51 9 1133-1154
Osborne S and Brown K (2005) Managing Change and Innovation in Public Service
Organizations London Routledge
Phills JA Deiglmeier K and Miller DT (2008) Rediscovering Social Innovation
Stamford Innovation Review 6 4 34-43
Sullivan M (1987) Sociology and Social Welfare London Allen and Unwin
Tidd J and Bessant J (2009) Managing Innovation Integrating Technological
Market and organizational Change 4th
edition Chichester John Wiley and Sons
UK Government Department of Health (2011) Innovation Health and Wealth
Accelerating adoption and diffusion in the NHS London Department of Health
Wolfensburger W (1975) The principle of normalisation in human services Toronto
National Institute on Mental Retardation
27
8 Appendices
Appendix 1 Summary of types and criteria of innovation used in Work Package
3 to identify practices
Identification of social service
Field(s) of service
Logic(s) of service
Self help or mutual aid logic Social care logic Multi-stakeholders logic Social
movements logic Combination
Activities of services delivered
Assistance for persons faced with personal challenges or crises (debt unemployment
drug addiction other) (Re)integration of persons into society (rehabilitation language
training for immigrants other) Services to the labour market (occupational training)
Social housing for disadvantaged groups Care (for the elderly children families )
Treatment and support of people with physical illnesses Treatment and support of
people with mental health problems Combination
Status of the provider organization
Public organization (governmental) Private organization ndash nonnot for profit Private
organization ndash profit Volunteer association Cooperative company or mutual company
Familyneighbourhood Civil society network Combination Other
Target group
Children Youngsters Elder people Unemployed people Poor people Immigrants
Disabled people People with chronic diseases ndash long-term health problems People with
acute or short term health problems No specific target group (eg territory-based social
services provision aiming at strengthen social ties) Combination Other
Size of the organization
Innovation
Type of innovation
New forms of organization resources hybridization new targeted actions new services
non-structural practices other
Innovative character
do the service practices appear to be something new in the field of social services
Origins of innovation
Supply side demand side broader operating factors
Impact on service performance
Effectiveness of service delivery
from user perspective cost effectivenesscapacity building sustainability of
innovation
Quality of provision
28
Socialization quality of life as judged by users and beneficiaries more inclusion
lower risk on exclusion participation of the user transition from institutional to
community based care
Potential wider effects
Promoting social and health equality sustainability new skills and jobs
increased social rights affordability of adequate and high quality health and long-
term care promotion of equality and non-discrimination equal access to adequate
provision
Transferability of innovations between national contexts
29
Appendix 2 levels of innovation identified within INNOSERV Work Package 2
literature review
Organizational level (policy organizational sectors)
New social services designed to face new needs or unmet needs
Search for new solutions to old needs new mechanisms or practices introduced in
preexisting
social services
to improve access to social services (ie more information increased
professionalism in
social work sector)
to guarantee entitlements (rights) for specific groups or minorities
to satisfy the demand for social services in a more complete and broad way
(holistic
approach)
to guarantee more participation and inclusion of citizens
New and increased Cross-Sectoral social services
Cross-Sectoral social services (ie teaching art to children while helping their mothers
for
job seeking and offering jobs for young artists)
Integrated care practices
Tearing down walls between sectors and the role of informal care
Sharing of knowledge
Better integration of Health and Social sector services
Territory based social services that contribute to the creation of training and job
opportunities for disadvantaged people
Solidarity-based social services
Social mediation for impaired and weakened people
Easy access to housing for poor families
New interfaces with clients
Logic(s) of service Self help or mutual aid logic Social care logic Multi-stakeholders
logic
Social movements logic
The development of the self-help sector
Actors New organizations (Cooperative society for social service provision ndashSCOP
Cooperative society as social enterprise with userrsquos involvement ndashSCIC)
New legal forms within structured public frameworks (Italy social cooperatives)
New provider organizations and existing organisations refashioned by new dynamics
New roles and relations among actors
New private organizations for profit and non-profit
Management style in the organization
Regulatory and legislative level
New architecture of the provision system
Socially responsible public contracts and social clauses (outsourcing)
Adherence to EU standards in transitional economies
Impact on institutional framework that shape innovation in social services
New arrangement between one or more government agencies andor external
organization
Organizational level ndash Connection and Cooperation (governance and partnership)
New networks and social movements established in order to design deliver and
finance
social services
Cooperation between sectors actors and different forms of provision
Cooperation between local actors
Increasing communication responsiveness
30
Utilizing connectivity and interdependencies
Modification of organizational systems (models of governance work organisation
number
of involved stakeholders in governance)
Public sector and local authorities as promoters of innovation and promoters of
crosssectoral
policy strategies
Third sector and user as promoters of innovation
Volunteer workers and initiatives launched by a group of citizens
Third sector and userrsquos engagement design (co-design and re-design services)
Joint decision process
Decision-making power not based on capital ownership
Employee and user driven innovation
Partnerships with users family carers and user organizations
Partnership between service users practitioners and academics
Community-based and participative health network in a local territory
Collaboration between public and volunteer organisations (NGOs) or between civil and
local
networks in collaboration with public organisations and social enterprises
New techniques for partnership building and functioning
Impact on social and power relations
Professional level (practitioners)
New practices in social work
Innovative tools (ie Theatre of the Oppressed) and the use of participated methods in
social
work (ie self-help group)
Networking
Individualised supports
New professional skills in social work
The use of informatics and new technologies in social work
Users
Participation and involvement of final users of services in designing delivering and
evaluating social services
Involvement of final users in promoting equality effectiveness and control and
adherence
to the needs of users
Conceptual Level (and value)
New models of society - Social goals participation user involvement community
benefit
New paradigms underlying a new social service concept or service delivery model (ie
new
inclusion paradigm active ageing)
Relationships and trust
Pursuing diversity
Better adjustment to usersrsquo needs more person centred support
More social services provision in less developed regions
New concept of accessibility of the service (ie for Roma families)
The concept of lsquoprogressive universalismrsquo
The Social Care Model
De-institutionalization and community care Improved home-based and community
services
Gender and diversity perspectives
Anti-discrimination and equality process
Increase of the level of recognition of social values objectives paradigms and goals
New models of interaction leading to social innovation processes
31
Public policy level (policy framework programs and social policies)
The new role of the system governance played by central (or local depending on
national
arrangements) government
Impact on public policies new public policy programme measure or intervention
Joint construction of a space for public action and redefinition of public governance
bodies
and methods
Innovative logics for public policies
Innovating the public sector
The new wide attention on anti stigma policies
E-government
Financial and economic sustainability level (and scaling-diffusion-transferability
of innovation)
New ways to overcome budgetary constraints
New approaches to acquire funding
The involvement of private investors
The introduction of special funds
The purchase of innovative practices by final users
Hybridization of resources (market redistribution and reciprocity resources)
New investment sources
Mobilising community resources taking full advantage of all endogenous resources
Improvement in efficiency and effectiveness
Financial and systemic sustainability Impact on the economy
Economic Environmental and Social Sustainability of Territory based social services
Financial tools necessary to territorial social initiatives and the way to unlock them
Capacity of spreading and diffusion
Evaluative level and attention for quality
Affordability availability and accessibility
New standards expected
New feedback loops from users and specialists
Social services of excellence as for quality efficiency and efficacy
New methods and creative tool-kits to strengthen and renew the quality of social care
services
Low-cost (for user) and high level quality of social services
Quality assurance moderation and accreditation mechanisms
New tools for monitoring social services - hearing all voices (users organizations
practioners staff family and friends)
Action research
Alternative economic and social indicators
Social impact and contribution of innovation in social services to social innovation and
social change ndash Assessment of innovation
Learning approach to evaluation ndash lsquoto learn from failuresrsquo
Developmental evaluation
Specifics for the Health sector
Disability from rehabilitation to integration and then to inclusion
Mental Health from segregation to inclusion and community care
HIV from segregationstigmatization to awareness campaigns for promoting self
protection
Innovation in the area of prevention of treatment and in the introduction of new
technologies
Emphasis on an inter-sectoral controlled and steered care in managed care models
replacement of the traditional insurance model
Integrated services
Technological progress
32
Specifics for the Education sector
Inclusive education
Inclusive education and training in collaboration with the civil society
Multicultural education
Integration of disciplines
Alternative schools non-regular schools and informal education
Link between formal and informal education
Community development based approaches
Connection between regular school and the system of social services
Experiential learning
Human rights education
Working lsquothrough relationshipsrsquo with children and young people
Problem based learning methodology
The lsquomedia educationrsquo The use of comics
ICT in schools
E-inclusion
Networks of schools
Improve supplement reinvent and transform learning
Sustained educational improvement
Learning Beyond the Classroom
Spreading a culture that values learning
More personalized approaches to learning
Using the web
Learning with and by not to and from
33
Appendix 3 analysis of social challenges and changes driving innovation
Welfare
Societal
change as
driving force
of innovation
in social
services
Meaning
description
Related
outcomesother
factors
Examples of innovative
responses
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
Empowerment self-
determination choice
The lsquoassertive userrsquo
Demand for more
individualised services of
better quality
Alternativecomplementary
providers
Personalisation
Co-production (new
userprofessional
relationships)
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demand on services
Potential for poor access
to services (from
communication
problems social
isolation)
Multiculturalism
Integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Declining female
caregiving
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
34
Increased demand for
services demand for
formal care
Continued
inequality
Continued
economic
inequality
unemployment
continued poverty
including child
poverty continued
institutionalisation
continued
inequality for
people with
disabilities ethnic
minorities gender
inequalities
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients
with complex
comorbidities increase
in certain diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing demand for
services Increasing
costsneed to make
limited resources go
further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
Decisions about value
marketization
Technological
development
Access to
information new
media technology
Facilitates self
determination increases
expectations and choice
population better
informed about
conditionsservicesright
s and less deferential
Users better able to
35
mobilise
Increased exclusion of
some groups with limited
access
New models of remote
care provision
Ability to exchange
information on quality
and experience
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Increasing costs
Decisions about value
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Organisational
change changing
management
styles
philosophies
Creating new
organisational
forms application
of more responsive
management
processes
performance
management
culture
Integration of
organisationsfunctions
new approaches to
lsquocommissioningrsquo of
organisationsservices
distortions caused by
lsquolocked inrsquo expenditures
(tertiary health care
residential care)
Decentralisation
deinstitutionalisation
marketization liberalisation
The lsquoenabling
statersquo Political
will fiscal space
Impact of financial
crisis competing
priorities for public
funds
Legacy of category-based
(not needs based) social
protection structural
transition
deindustrialisation
Health
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
EmpowermentSelf-
determination choice
Demand for more
individualised services of
better quality
Users better able to mobilise
Assertive lsquouserrsquo
knowledgeable patient
Alternativecomplimentary
providers
36
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demands on
services
Potential for poor access
to services (from
communication
problems social
isolation)
MulticulturalismTrained
health professionals
move to richer countries
integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Declining female
caregiving
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
Increased demand for
formal care services
Continued
inequalities
Unequal
distribution of
health risks and
health
outcomediseases
by socioeconomic
indicators
Unequal access to
care by social
status geography
gender and
ethnicity
Demographic Increase in
numbers of over
Increase in patients with
complex comorbidities
Increasing demand for care
Decisions about value Active
37
change 65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing costsneed to
make limited resources
go further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
ageing paradigm
Technological
development
Access to
information new
media technology
Self determination
expectations choice
population better
informed about
conditionsservicesright
s and less deferential
Ability to exchange
information on quality
and experience
New models of care provision
(eg telehealth care) new
health management systems
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Changing
management
stylesphilosophi
es
Application of
more responsive
management
processes
Decentralisation
deinstitutionalisation
marketization liberalisation
Lifestyle changes Increase in certain
diseases related to
obesity alcohol
and drug
Increasing
costsdemands for care
38
consumption and
stress diabetes
liver disease
anxiety and
depression
Education
Aspirations Rising expectations
by citizens for
better quality of
life
Self determination
choice consumerism
Education outside of formal
setting
Assertive user
Lifelong learningeducation
Migration Historical (post
colonial) migration
pan-EU migration
refugees
New needs for education
eg language and culture
Inequalities social
fragmentation
Social Roles Changing family
structure increase
in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
changing gender
roles rising
female
employment rates
Need to reconcile work
and family life
Parentingfamily skills
for vulnerable
parentsfamilies
Socialization of children
ndash social and emotional
deficits for children in
some environments
Work with families and
communities
Continued
inequalities
Inequality in
educational
accessattainment
by socioeconomic
status gender
people with
disabilities ethnic
minorities
Culture of failure
Promise to deliver social
mobility and economic
improvement
(Leadbeater and Wond
2010 pp 5-20)
Inclusive and multicultural
education
Differential support for
children from
lsquodisadvantagedrsquo
backgrounds
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients with
complex comorbidities
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
New group of older
39
learners
Technological
advance
Access to
information new
media technology
making learning
available in new
ways
Self determination
expectations choice
lsquoAssertive userrsquo
Increased exclusion of
some groups with limited
access
Changing
management
styles
philosophies
Community based models
Globalization Need to provide
educationtraining
which is suited to
modern knowledge
based global
economies
This report for the InnoServ project (grant agreement nr 290542) is supported
under the Socio-economic and Humanities Programme of FP7
Chris Hawker
Faculty of Health Sciences University of Southampton Building 67 University Road Highfield Campus Southampton SO17 1BJ
Tel +44 (0)23 8059 7968
Email CHawkersotonacuk
24
6 Conclusions and next steps
This report has presented the framework which has been used within the INNOSERV
project to support the choice of innovative case studies and to assist in identifying
the innovation phenomena potential and processes important to future research in
this area The framework has been used to select projects as case studies (see Work
Package 4 report Eurich and Strifler 2012) The framework interlinks aspects of
innovation (novelty type context improvement sustainability) with analysis of
challenges and changes which are acting as driving forces of innovation in social
services As the project is future facing it is proposed that key social challenges
and changes are likely to inform the development of new change paradigms for the
delivery of social services across Europe The framework will inform further
development and testing of concepts through the next stages of the INNOSERVE
programme This process will result in descriptions for the key areas in which future
research on innovation in social services should be taken forward
25
7 Bibliography
Bason C (2010) Leading public sector innovation Co-creating for a better society
Bristol The Policy Press
Bereiter C (2002) Design research for sustained innovation Cognitive Studies
Bulletin of the Japanese Cognitive Society 9 321-327
Christensen CM and Overdorf M (2000) Meeting the Challenge of Disruptive
Change Harvard Business Review March-April
Clark M and Goodwin N (2010) Sustaining innovation in telehealth and telecare
WSDNA briefing paper London The Kings Fund
Crepaldi C De Rosa E And Pesce F (2012) Literature review on innovation in
social services in Europe (sectors of Health Education and Welfare
Services)INNOSERV Work Package 1 report
Department of Health (2011) Innovation Health and Wealth Accelerating Adoption
and Diffusion in the NHS London Department of Health
Eurich J and Strifler A (2012) European compared selection of innovative social
services INNOSERV Work Package 4 report
Fuglsang L (2010) Bricolage and invisible innovation in public service innovation
Journal of Innovation Economics 5 67-87
Greenhalgh T Robert G Macfarlane F Bate P Kyriakidou O (2004) Diffusion of
innovations in service organizations systematic review and recommendations
Milbank Quarterly 82581-629
Hartley J (2005) Innovation in Governance and Public Services Past and Present
Public Money and Management 25127-34
Koch P and Hauknes J (2005) On innovation in the Public Sector Publin report no
D20
Kuhn T (1962) The Structure of Scientific Revolutions Chicago The University of
Chicago Press
Lakatos I and Musgrave A (eds) (1970) Criticism and the growth of knowledge
London Cambridge University Press
May
C Finch T Mair F et al ( 2007) Understanding the implementation of
complex interventions in health care the normalization process model BMC Health
Services Research 2007 7148 doi1011861472-6963-7-148
May et al (2009) Implementing Embedding and Integrating Practices An Outline of
Normalization Process Theory Sociology 43 535-554
Murray R Caulier-Grice J and Mulgan G (2010) The Open Book of Social
Innovation London The Young Foundation
26
OECD (2005) Oslo manual Guidelines for collecting and interpreting innovation
data 3rd
edition
Oliver M (1990) The politics of disablement Basingstoke Macmillan Education Ltd
Osborne S (1998) Naming the Beast Defining and Classifying Service Innovations
in Social Policy Human Relations 51 9 1133-1154
Osborne S and Brown K (2005) Managing Change and Innovation in Public Service
Organizations London Routledge
Phills JA Deiglmeier K and Miller DT (2008) Rediscovering Social Innovation
Stamford Innovation Review 6 4 34-43
Sullivan M (1987) Sociology and Social Welfare London Allen and Unwin
Tidd J and Bessant J (2009) Managing Innovation Integrating Technological
Market and organizational Change 4th
edition Chichester John Wiley and Sons
UK Government Department of Health (2011) Innovation Health and Wealth
Accelerating adoption and diffusion in the NHS London Department of Health
Wolfensburger W (1975) The principle of normalisation in human services Toronto
National Institute on Mental Retardation
27
8 Appendices
Appendix 1 Summary of types and criteria of innovation used in Work Package
3 to identify practices
Identification of social service
Field(s) of service
Logic(s) of service
Self help or mutual aid logic Social care logic Multi-stakeholders logic Social
movements logic Combination
Activities of services delivered
Assistance for persons faced with personal challenges or crises (debt unemployment
drug addiction other) (Re)integration of persons into society (rehabilitation language
training for immigrants other) Services to the labour market (occupational training)
Social housing for disadvantaged groups Care (for the elderly children families )
Treatment and support of people with physical illnesses Treatment and support of
people with mental health problems Combination
Status of the provider organization
Public organization (governmental) Private organization ndash nonnot for profit Private
organization ndash profit Volunteer association Cooperative company or mutual company
Familyneighbourhood Civil society network Combination Other
Target group
Children Youngsters Elder people Unemployed people Poor people Immigrants
Disabled people People with chronic diseases ndash long-term health problems People with
acute or short term health problems No specific target group (eg territory-based social
services provision aiming at strengthen social ties) Combination Other
Size of the organization
Innovation
Type of innovation
New forms of organization resources hybridization new targeted actions new services
non-structural practices other
Innovative character
do the service practices appear to be something new in the field of social services
Origins of innovation
Supply side demand side broader operating factors
Impact on service performance
Effectiveness of service delivery
from user perspective cost effectivenesscapacity building sustainability of
innovation
Quality of provision
28
Socialization quality of life as judged by users and beneficiaries more inclusion
lower risk on exclusion participation of the user transition from institutional to
community based care
Potential wider effects
Promoting social and health equality sustainability new skills and jobs
increased social rights affordability of adequate and high quality health and long-
term care promotion of equality and non-discrimination equal access to adequate
provision
Transferability of innovations between national contexts
29
Appendix 2 levels of innovation identified within INNOSERV Work Package 2
literature review
Organizational level (policy organizational sectors)
New social services designed to face new needs or unmet needs
Search for new solutions to old needs new mechanisms or practices introduced in
preexisting
social services
to improve access to social services (ie more information increased
professionalism in
social work sector)
to guarantee entitlements (rights) for specific groups or minorities
to satisfy the demand for social services in a more complete and broad way
(holistic
approach)
to guarantee more participation and inclusion of citizens
New and increased Cross-Sectoral social services
Cross-Sectoral social services (ie teaching art to children while helping their mothers
for
job seeking and offering jobs for young artists)
Integrated care practices
Tearing down walls between sectors and the role of informal care
Sharing of knowledge
Better integration of Health and Social sector services
Territory based social services that contribute to the creation of training and job
opportunities for disadvantaged people
Solidarity-based social services
Social mediation for impaired and weakened people
Easy access to housing for poor families
New interfaces with clients
Logic(s) of service Self help or mutual aid logic Social care logic Multi-stakeholders
logic
Social movements logic
The development of the self-help sector
Actors New organizations (Cooperative society for social service provision ndashSCOP
Cooperative society as social enterprise with userrsquos involvement ndashSCIC)
New legal forms within structured public frameworks (Italy social cooperatives)
New provider organizations and existing organisations refashioned by new dynamics
New roles and relations among actors
New private organizations for profit and non-profit
Management style in the organization
Regulatory and legislative level
New architecture of the provision system
Socially responsible public contracts and social clauses (outsourcing)
Adherence to EU standards in transitional economies
Impact on institutional framework that shape innovation in social services
New arrangement between one or more government agencies andor external
organization
Organizational level ndash Connection and Cooperation (governance and partnership)
New networks and social movements established in order to design deliver and
finance
social services
Cooperation between sectors actors and different forms of provision
Cooperation between local actors
Increasing communication responsiveness
30
Utilizing connectivity and interdependencies
Modification of organizational systems (models of governance work organisation
number
of involved stakeholders in governance)
Public sector and local authorities as promoters of innovation and promoters of
crosssectoral
policy strategies
Third sector and user as promoters of innovation
Volunteer workers and initiatives launched by a group of citizens
Third sector and userrsquos engagement design (co-design and re-design services)
Joint decision process
Decision-making power not based on capital ownership
Employee and user driven innovation
Partnerships with users family carers and user organizations
Partnership between service users practitioners and academics
Community-based and participative health network in a local territory
Collaboration between public and volunteer organisations (NGOs) or between civil and
local
networks in collaboration with public organisations and social enterprises
New techniques for partnership building and functioning
Impact on social and power relations
Professional level (practitioners)
New practices in social work
Innovative tools (ie Theatre of the Oppressed) and the use of participated methods in
social
work (ie self-help group)
Networking
Individualised supports
New professional skills in social work
The use of informatics and new technologies in social work
Users
Participation and involvement of final users of services in designing delivering and
evaluating social services
Involvement of final users in promoting equality effectiveness and control and
adherence
to the needs of users
Conceptual Level (and value)
New models of society - Social goals participation user involvement community
benefit
New paradigms underlying a new social service concept or service delivery model (ie
new
inclusion paradigm active ageing)
Relationships and trust
Pursuing diversity
Better adjustment to usersrsquo needs more person centred support
More social services provision in less developed regions
New concept of accessibility of the service (ie for Roma families)
The concept of lsquoprogressive universalismrsquo
The Social Care Model
De-institutionalization and community care Improved home-based and community
services
Gender and diversity perspectives
Anti-discrimination and equality process
Increase of the level of recognition of social values objectives paradigms and goals
New models of interaction leading to social innovation processes
31
Public policy level (policy framework programs and social policies)
The new role of the system governance played by central (or local depending on
national
arrangements) government
Impact on public policies new public policy programme measure or intervention
Joint construction of a space for public action and redefinition of public governance
bodies
and methods
Innovative logics for public policies
Innovating the public sector
The new wide attention on anti stigma policies
E-government
Financial and economic sustainability level (and scaling-diffusion-transferability
of innovation)
New ways to overcome budgetary constraints
New approaches to acquire funding
The involvement of private investors
The introduction of special funds
The purchase of innovative practices by final users
Hybridization of resources (market redistribution and reciprocity resources)
New investment sources
Mobilising community resources taking full advantage of all endogenous resources
Improvement in efficiency and effectiveness
Financial and systemic sustainability Impact on the economy
Economic Environmental and Social Sustainability of Territory based social services
Financial tools necessary to territorial social initiatives and the way to unlock them
Capacity of spreading and diffusion
Evaluative level and attention for quality
Affordability availability and accessibility
New standards expected
New feedback loops from users and specialists
Social services of excellence as for quality efficiency and efficacy
New methods and creative tool-kits to strengthen and renew the quality of social care
services
Low-cost (for user) and high level quality of social services
Quality assurance moderation and accreditation mechanisms
New tools for monitoring social services - hearing all voices (users organizations
practioners staff family and friends)
Action research
Alternative economic and social indicators
Social impact and contribution of innovation in social services to social innovation and
social change ndash Assessment of innovation
Learning approach to evaluation ndash lsquoto learn from failuresrsquo
Developmental evaluation
Specifics for the Health sector
Disability from rehabilitation to integration and then to inclusion
Mental Health from segregation to inclusion and community care
HIV from segregationstigmatization to awareness campaigns for promoting self
protection
Innovation in the area of prevention of treatment and in the introduction of new
technologies
Emphasis on an inter-sectoral controlled and steered care in managed care models
replacement of the traditional insurance model
Integrated services
Technological progress
32
Specifics for the Education sector
Inclusive education
Inclusive education and training in collaboration with the civil society
Multicultural education
Integration of disciplines
Alternative schools non-regular schools and informal education
Link between formal and informal education
Community development based approaches
Connection between regular school and the system of social services
Experiential learning
Human rights education
Working lsquothrough relationshipsrsquo with children and young people
Problem based learning methodology
The lsquomedia educationrsquo The use of comics
ICT in schools
E-inclusion
Networks of schools
Improve supplement reinvent and transform learning
Sustained educational improvement
Learning Beyond the Classroom
Spreading a culture that values learning
More personalized approaches to learning
Using the web
Learning with and by not to and from
33
Appendix 3 analysis of social challenges and changes driving innovation
Welfare
Societal
change as
driving force
of innovation
in social
services
Meaning
description
Related
outcomesother
factors
Examples of innovative
responses
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
Empowerment self-
determination choice
The lsquoassertive userrsquo
Demand for more
individualised services of
better quality
Alternativecomplementary
providers
Personalisation
Co-production (new
userprofessional
relationships)
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demand on services
Potential for poor access
to services (from
communication
problems social
isolation)
Multiculturalism
Integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Declining female
caregiving
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
34
Increased demand for
services demand for
formal care
Continued
inequality
Continued
economic
inequality
unemployment
continued poverty
including child
poverty continued
institutionalisation
continued
inequality for
people with
disabilities ethnic
minorities gender
inequalities
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients
with complex
comorbidities increase
in certain diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing demand for
services Increasing
costsneed to make
limited resources go
further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
Decisions about value
marketization
Technological
development
Access to
information new
media technology
Facilitates self
determination increases
expectations and choice
population better
informed about
conditionsservicesright
s and less deferential
Users better able to
35
mobilise
Increased exclusion of
some groups with limited
access
New models of remote
care provision
Ability to exchange
information on quality
and experience
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Increasing costs
Decisions about value
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Organisational
change changing
management
styles
philosophies
Creating new
organisational
forms application
of more responsive
management
processes
performance
management
culture
Integration of
organisationsfunctions
new approaches to
lsquocommissioningrsquo of
organisationsservices
distortions caused by
lsquolocked inrsquo expenditures
(tertiary health care
residential care)
Decentralisation
deinstitutionalisation
marketization liberalisation
The lsquoenabling
statersquo Political
will fiscal space
Impact of financial
crisis competing
priorities for public
funds
Legacy of category-based
(not needs based) social
protection structural
transition
deindustrialisation
Health
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
EmpowermentSelf-
determination choice
Demand for more
individualised services of
better quality
Users better able to mobilise
Assertive lsquouserrsquo
knowledgeable patient
Alternativecomplimentary
providers
36
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demands on
services
Potential for poor access
to services (from
communication
problems social
isolation)
MulticulturalismTrained
health professionals
move to richer countries
integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Declining female
caregiving
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
Increased demand for
formal care services
Continued
inequalities
Unequal
distribution of
health risks and
health
outcomediseases
by socioeconomic
indicators
Unequal access to
care by social
status geography
gender and
ethnicity
Demographic Increase in
numbers of over
Increase in patients with
complex comorbidities
Increasing demand for care
Decisions about value Active
37
change 65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing costsneed to
make limited resources
go further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
ageing paradigm
Technological
development
Access to
information new
media technology
Self determination
expectations choice
population better
informed about
conditionsservicesright
s and less deferential
Ability to exchange
information on quality
and experience
New models of care provision
(eg telehealth care) new
health management systems
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Changing
management
stylesphilosophi
es
Application of
more responsive
management
processes
Decentralisation
deinstitutionalisation
marketization liberalisation
Lifestyle changes Increase in certain
diseases related to
obesity alcohol
and drug
Increasing
costsdemands for care
38
consumption and
stress diabetes
liver disease
anxiety and
depression
Education
Aspirations Rising expectations
by citizens for
better quality of
life
Self determination
choice consumerism
Education outside of formal
setting
Assertive user
Lifelong learningeducation
Migration Historical (post
colonial) migration
pan-EU migration
refugees
New needs for education
eg language and culture
Inequalities social
fragmentation
Social Roles Changing family
structure increase
in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
changing gender
roles rising
female
employment rates
Need to reconcile work
and family life
Parentingfamily skills
for vulnerable
parentsfamilies
Socialization of children
ndash social and emotional
deficits for children in
some environments
Work with families and
communities
Continued
inequalities
Inequality in
educational
accessattainment
by socioeconomic
status gender
people with
disabilities ethnic
minorities
Culture of failure
Promise to deliver social
mobility and economic
improvement
(Leadbeater and Wond
2010 pp 5-20)
Inclusive and multicultural
education
Differential support for
children from
lsquodisadvantagedrsquo
backgrounds
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients with
complex comorbidities
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
New group of older
39
learners
Technological
advance
Access to
information new
media technology
making learning
available in new
ways
Self determination
expectations choice
lsquoAssertive userrsquo
Increased exclusion of
some groups with limited
access
Changing
management
styles
philosophies
Community based models
Globalization Need to provide
educationtraining
which is suited to
modern knowledge
based global
economies
This report for the InnoServ project (grant agreement nr 290542) is supported
under the Socio-economic and Humanities Programme of FP7
Chris Hawker
Faculty of Health Sciences University of Southampton Building 67 University Road Highfield Campus Southampton SO17 1BJ
Tel +44 (0)23 8059 7968
Email CHawkersotonacuk
25
7 Bibliography
Bason C (2010) Leading public sector innovation Co-creating for a better society
Bristol The Policy Press
Bereiter C (2002) Design research for sustained innovation Cognitive Studies
Bulletin of the Japanese Cognitive Society 9 321-327
Christensen CM and Overdorf M (2000) Meeting the Challenge of Disruptive
Change Harvard Business Review March-April
Clark M and Goodwin N (2010) Sustaining innovation in telehealth and telecare
WSDNA briefing paper London The Kings Fund
Crepaldi C De Rosa E And Pesce F (2012) Literature review on innovation in
social services in Europe (sectors of Health Education and Welfare
Services)INNOSERV Work Package 1 report
Department of Health (2011) Innovation Health and Wealth Accelerating Adoption
and Diffusion in the NHS London Department of Health
Eurich J and Strifler A (2012) European compared selection of innovative social
services INNOSERV Work Package 4 report
Fuglsang L (2010) Bricolage and invisible innovation in public service innovation
Journal of Innovation Economics 5 67-87
Greenhalgh T Robert G Macfarlane F Bate P Kyriakidou O (2004) Diffusion of
innovations in service organizations systematic review and recommendations
Milbank Quarterly 82581-629
Hartley J (2005) Innovation in Governance and Public Services Past and Present
Public Money and Management 25127-34
Koch P and Hauknes J (2005) On innovation in the Public Sector Publin report no
D20
Kuhn T (1962) The Structure of Scientific Revolutions Chicago The University of
Chicago Press
Lakatos I and Musgrave A (eds) (1970) Criticism and the growth of knowledge
London Cambridge University Press
May
C Finch T Mair F et al ( 2007) Understanding the implementation of
complex interventions in health care the normalization process model BMC Health
Services Research 2007 7148 doi1011861472-6963-7-148
May et al (2009) Implementing Embedding and Integrating Practices An Outline of
Normalization Process Theory Sociology 43 535-554
Murray R Caulier-Grice J and Mulgan G (2010) The Open Book of Social
Innovation London The Young Foundation
26
OECD (2005) Oslo manual Guidelines for collecting and interpreting innovation
data 3rd
edition
Oliver M (1990) The politics of disablement Basingstoke Macmillan Education Ltd
Osborne S (1998) Naming the Beast Defining and Classifying Service Innovations
in Social Policy Human Relations 51 9 1133-1154
Osborne S and Brown K (2005) Managing Change and Innovation in Public Service
Organizations London Routledge
Phills JA Deiglmeier K and Miller DT (2008) Rediscovering Social Innovation
Stamford Innovation Review 6 4 34-43
Sullivan M (1987) Sociology and Social Welfare London Allen and Unwin
Tidd J and Bessant J (2009) Managing Innovation Integrating Technological
Market and organizational Change 4th
edition Chichester John Wiley and Sons
UK Government Department of Health (2011) Innovation Health and Wealth
Accelerating adoption and diffusion in the NHS London Department of Health
Wolfensburger W (1975) The principle of normalisation in human services Toronto
National Institute on Mental Retardation
27
8 Appendices
Appendix 1 Summary of types and criteria of innovation used in Work Package
3 to identify practices
Identification of social service
Field(s) of service
Logic(s) of service
Self help or mutual aid logic Social care logic Multi-stakeholders logic Social
movements logic Combination
Activities of services delivered
Assistance for persons faced with personal challenges or crises (debt unemployment
drug addiction other) (Re)integration of persons into society (rehabilitation language
training for immigrants other) Services to the labour market (occupational training)
Social housing for disadvantaged groups Care (for the elderly children families )
Treatment and support of people with physical illnesses Treatment and support of
people with mental health problems Combination
Status of the provider organization
Public organization (governmental) Private organization ndash nonnot for profit Private
organization ndash profit Volunteer association Cooperative company or mutual company
Familyneighbourhood Civil society network Combination Other
Target group
Children Youngsters Elder people Unemployed people Poor people Immigrants
Disabled people People with chronic diseases ndash long-term health problems People with
acute or short term health problems No specific target group (eg territory-based social
services provision aiming at strengthen social ties) Combination Other
Size of the organization
Innovation
Type of innovation
New forms of organization resources hybridization new targeted actions new services
non-structural practices other
Innovative character
do the service practices appear to be something new in the field of social services
Origins of innovation
Supply side demand side broader operating factors
Impact on service performance
Effectiveness of service delivery
from user perspective cost effectivenesscapacity building sustainability of
innovation
Quality of provision
28
Socialization quality of life as judged by users and beneficiaries more inclusion
lower risk on exclusion participation of the user transition from institutional to
community based care
Potential wider effects
Promoting social and health equality sustainability new skills and jobs
increased social rights affordability of adequate and high quality health and long-
term care promotion of equality and non-discrimination equal access to adequate
provision
Transferability of innovations between national contexts
29
Appendix 2 levels of innovation identified within INNOSERV Work Package 2
literature review
Organizational level (policy organizational sectors)
New social services designed to face new needs or unmet needs
Search for new solutions to old needs new mechanisms or practices introduced in
preexisting
social services
to improve access to social services (ie more information increased
professionalism in
social work sector)
to guarantee entitlements (rights) for specific groups or minorities
to satisfy the demand for social services in a more complete and broad way
(holistic
approach)
to guarantee more participation and inclusion of citizens
New and increased Cross-Sectoral social services
Cross-Sectoral social services (ie teaching art to children while helping their mothers
for
job seeking and offering jobs for young artists)
Integrated care practices
Tearing down walls between sectors and the role of informal care
Sharing of knowledge
Better integration of Health and Social sector services
Territory based social services that contribute to the creation of training and job
opportunities for disadvantaged people
Solidarity-based social services
Social mediation for impaired and weakened people
Easy access to housing for poor families
New interfaces with clients
Logic(s) of service Self help or mutual aid logic Social care logic Multi-stakeholders
logic
Social movements logic
The development of the self-help sector
Actors New organizations (Cooperative society for social service provision ndashSCOP
Cooperative society as social enterprise with userrsquos involvement ndashSCIC)
New legal forms within structured public frameworks (Italy social cooperatives)
New provider organizations and existing organisations refashioned by new dynamics
New roles and relations among actors
New private organizations for profit and non-profit
Management style in the organization
Regulatory and legislative level
New architecture of the provision system
Socially responsible public contracts and social clauses (outsourcing)
Adherence to EU standards in transitional economies
Impact on institutional framework that shape innovation in social services
New arrangement between one or more government agencies andor external
organization
Organizational level ndash Connection and Cooperation (governance and partnership)
New networks and social movements established in order to design deliver and
finance
social services
Cooperation between sectors actors and different forms of provision
Cooperation between local actors
Increasing communication responsiveness
30
Utilizing connectivity and interdependencies
Modification of organizational systems (models of governance work organisation
number
of involved stakeholders in governance)
Public sector and local authorities as promoters of innovation and promoters of
crosssectoral
policy strategies
Third sector and user as promoters of innovation
Volunteer workers and initiatives launched by a group of citizens
Third sector and userrsquos engagement design (co-design and re-design services)
Joint decision process
Decision-making power not based on capital ownership
Employee and user driven innovation
Partnerships with users family carers and user organizations
Partnership between service users practitioners and academics
Community-based and participative health network in a local territory
Collaboration between public and volunteer organisations (NGOs) or between civil and
local
networks in collaboration with public organisations and social enterprises
New techniques for partnership building and functioning
Impact on social and power relations
Professional level (practitioners)
New practices in social work
Innovative tools (ie Theatre of the Oppressed) and the use of participated methods in
social
work (ie self-help group)
Networking
Individualised supports
New professional skills in social work
The use of informatics and new technologies in social work
Users
Participation and involvement of final users of services in designing delivering and
evaluating social services
Involvement of final users in promoting equality effectiveness and control and
adherence
to the needs of users
Conceptual Level (and value)
New models of society - Social goals participation user involvement community
benefit
New paradigms underlying a new social service concept or service delivery model (ie
new
inclusion paradigm active ageing)
Relationships and trust
Pursuing diversity
Better adjustment to usersrsquo needs more person centred support
More social services provision in less developed regions
New concept of accessibility of the service (ie for Roma families)
The concept of lsquoprogressive universalismrsquo
The Social Care Model
De-institutionalization and community care Improved home-based and community
services
Gender and diversity perspectives
Anti-discrimination and equality process
Increase of the level of recognition of social values objectives paradigms and goals
New models of interaction leading to social innovation processes
31
Public policy level (policy framework programs and social policies)
The new role of the system governance played by central (or local depending on
national
arrangements) government
Impact on public policies new public policy programme measure or intervention
Joint construction of a space for public action and redefinition of public governance
bodies
and methods
Innovative logics for public policies
Innovating the public sector
The new wide attention on anti stigma policies
E-government
Financial and economic sustainability level (and scaling-diffusion-transferability
of innovation)
New ways to overcome budgetary constraints
New approaches to acquire funding
The involvement of private investors
The introduction of special funds
The purchase of innovative practices by final users
Hybridization of resources (market redistribution and reciprocity resources)
New investment sources
Mobilising community resources taking full advantage of all endogenous resources
Improvement in efficiency and effectiveness
Financial and systemic sustainability Impact on the economy
Economic Environmental and Social Sustainability of Territory based social services
Financial tools necessary to territorial social initiatives and the way to unlock them
Capacity of spreading and diffusion
Evaluative level and attention for quality
Affordability availability and accessibility
New standards expected
New feedback loops from users and specialists
Social services of excellence as for quality efficiency and efficacy
New methods and creative tool-kits to strengthen and renew the quality of social care
services
Low-cost (for user) and high level quality of social services
Quality assurance moderation and accreditation mechanisms
New tools for monitoring social services - hearing all voices (users organizations
practioners staff family and friends)
Action research
Alternative economic and social indicators
Social impact and contribution of innovation in social services to social innovation and
social change ndash Assessment of innovation
Learning approach to evaluation ndash lsquoto learn from failuresrsquo
Developmental evaluation
Specifics for the Health sector
Disability from rehabilitation to integration and then to inclusion
Mental Health from segregation to inclusion and community care
HIV from segregationstigmatization to awareness campaigns for promoting self
protection
Innovation in the area of prevention of treatment and in the introduction of new
technologies
Emphasis on an inter-sectoral controlled and steered care in managed care models
replacement of the traditional insurance model
Integrated services
Technological progress
32
Specifics for the Education sector
Inclusive education
Inclusive education and training in collaboration with the civil society
Multicultural education
Integration of disciplines
Alternative schools non-regular schools and informal education
Link between formal and informal education
Community development based approaches
Connection between regular school and the system of social services
Experiential learning
Human rights education
Working lsquothrough relationshipsrsquo with children and young people
Problem based learning methodology
The lsquomedia educationrsquo The use of comics
ICT in schools
E-inclusion
Networks of schools
Improve supplement reinvent and transform learning
Sustained educational improvement
Learning Beyond the Classroom
Spreading a culture that values learning
More personalized approaches to learning
Using the web
Learning with and by not to and from
33
Appendix 3 analysis of social challenges and changes driving innovation
Welfare
Societal
change as
driving force
of innovation
in social
services
Meaning
description
Related
outcomesother
factors
Examples of innovative
responses
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
Empowerment self-
determination choice
The lsquoassertive userrsquo
Demand for more
individualised services of
better quality
Alternativecomplementary
providers
Personalisation
Co-production (new
userprofessional
relationships)
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demand on services
Potential for poor access
to services (from
communication
problems social
isolation)
Multiculturalism
Integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Declining female
caregiving
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
34
Increased demand for
services demand for
formal care
Continued
inequality
Continued
economic
inequality
unemployment
continued poverty
including child
poverty continued
institutionalisation
continued
inequality for
people with
disabilities ethnic
minorities gender
inequalities
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients
with complex
comorbidities increase
in certain diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing demand for
services Increasing
costsneed to make
limited resources go
further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
Decisions about value
marketization
Technological
development
Access to
information new
media technology
Facilitates self
determination increases
expectations and choice
population better
informed about
conditionsservicesright
s and less deferential
Users better able to
35
mobilise
Increased exclusion of
some groups with limited
access
New models of remote
care provision
Ability to exchange
information on quality
and experience
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Increasing costs
Decisions about value
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Organisational
change changing
management
styles
philosophies
Creating new
organisational
forms application
of more responsive
management
processes
performance
management
culture
Integration of
organisationsfunctions
new approaches to
lsquocommissioningrsquo of
organisationsservices
distortions caused by
lsquolocked inrsquo expenditures
(tertiary health care
residential care)
Decentralisation
deinstitutionalisation
marketization liberalisation
The lsquoenabling
statersquo Political
will fiscal space
Impact of financial
crisis competing
priorities for public
funds
Legacy of category-based
(not needs based) social
protection structural
transition
deindustrialisation
Health
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
EmpowermentSelf-
determination choice
Demand for more
individualised services of
better quality
Users better able to mobilise
Assertive lsquouserrsquo
knowledgeable patient
Alternativecomplimentary
providers
36
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demands on
services
Potential for poor access
to services (from
communication
problems social
isolation)
MulticulturalismTrained
health professionals
move to richer countries
integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Declining female
caregiving
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
Increased demand for
formal care services
Continued
inequalities
Unequal
distribution of
health risks and
health
outcomediseases
by socioeconomic
indicators
Unequal access to
care by social
status geography
gender and
ethnicity
Demographic Increase in
numbers of over
Increase in patients with
complex comorbidities
Increasing demand for care
Decisions about value Active
37
change 65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing costsneed to
make limited resources
go further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
ageing paradigm
Technological
development
Access to
information new
media technology
Self determination
expectations choice
population better
informed about
conditionsservicesright
s and less deferential
Ability to exchange
information on quality
and experience
New models of care provision
(eg telehealth care) new
health management systems
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Changing
management
stylesphilosophi
es
Application of
more responsive
management
processes
Decentralisation
deinstitutionalisation
marketization liberalisation
Lifestyle changes Increase in certain
diseases related to
obesity alcohol
and drug
Increasing
costsdemands for care
38
consumption and
stress diabetes
liver disease
anxiety and
depression
Education
Aspirations Rising expectations
by citizens for
better quality of
life
Self determination
choice consumerism
Education outside of formal
setting
Assertive user
Lifelong learningeducation
Migration Historical (post
colonial) migration
pan-EU migration
refugees
New needs for education
eg language and culture
Inequalities social
fragmentation
Social Roles Changing family
structure increase
in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
changing gender
roles rising
female
employment rates
Need to reconcile work
and family life
Parentingfamily skills
for vulnerable
parentsfamilies
Socialization of children
ndash social and emotional
deficits for children in
some environments
Work with families and
communities
Continued
inequalities
Inequality in
educational
accessattainment
by socioeconomic
status gender
people with
disabilities ethnic
minorities
Culture of failure
Promise to deliver social
mobility and economic
improvement
(Leadbeater and Wond
2010 pp 5-20)
Inclusive and multicultural
education
Differential support for
children from
lsquodisadvantagedrsquo
backgrounds
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients with
complex comorbidities
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
New group of older
39
learners
Technological
advance
Access to
information new
media technology
making learning
available in new
ways
Self determination
expectations choice
lsquoAssertive userrsquo
Increased exclusion of
some groups with limited
access
Changing
management
styles
philosophies
Community based models
Globalization Need to provide
educationtraining
which is suited to
modern knowledge
based global
economies
This report for the InnoServ project (grant agreement nr 290542) is supported
under the Socio-economic and Humanities Programme of FP7
Chris Hawker
Faculty of Health Sciences University of Southampton Building 67 University Road Highfield Campus Southampton SO17 1BJ
Tel +44 (0)23 8059 7968
Email CHawkersotonacuk
26
OECD (2005) Oslo manual Guidelines for collecting and interpreting innovation
data 3rd
edition
Oliver M (1990) The politics of disablement Basingstoke Macmillan Education Ltd
Osborne S (1998) Naming the Beast Defining and Classifying Service Innovations
in Social Policy Human Relations 51 9 1133-1154
Osborne S and Brown K (2005) Managing Change and Innovation in Public Service
Organizations London Routledge
Phills JA Deiglmeier K and Miller DT (2008) Rediscovering Social Innovation
Stamford Innovation Review 6 4 34-43
Sullivan M (1987) Sociology and Social Welfare London Allen and Unwin
Tidd J and Bessant J (2009) Managing Innovation Integrating Technological
Market and organizational Change 4th
edition Chichester John Wiley and Sons
UK Government Department of Health (2011) Innovation Health and Wealth
Accelerating adoption and diffusion in the NHS London Department of Health
Wolfensburger W (1975) The principle of normalisation in human services Toronto
National Institute on Mental Retardation
27
8 Appendices
Appendix 1 Summary of types and criteria of innovation used in Work Package
3 to identify practices
Identification of social service
Field(s) of service
Logic(s) of service
Self help or mutual aid logic Social care logic Multi-stakeholders logic Social
movements logic Combination
Activities of services delivered
Assistance for persons faced with personal challenges or crises (debt unemployment
drug addiction other) (Re)integration of persons into society (rehabilitation language
training for immigrants other) Services to the labour market (occupational training)
Social housing for disadvantaged groups Care (for the elderly children families )
Treatment and support of people with physical illnesses Treatment and support of
people with mental health problems Combination
Status of the provider organization
Public organization (governmental) Private organization ndash nonnot for profit Private
organization ndash profit Volunteer association Cooperative company or mutual company
Familyneighbourhood Civil society network Combination Other
Target group
Children Youngsters Elder people Unemployed people Poor people Immigrants
Disabled people People with chronic diseases ndash long-term health problems People with
acute or short term health problems No specific target group (eg territory-based social
services provision aiming at strengthen social ties) Combination Other
Size of the organization
Innovation
Type of innovation
New forms of organization resources hybridization new targeted actions new services
non-structural practices other
Innovative character
do the service practices appear to be something new in the field of social services
Origins of innovation
Supply side demand side broader operating factors
Impact on service performance
Effectiveness of service delivery
from user perspective cost effectivenesscapacity building sustainability of
innovation
Quality of provision
28
Socialization quality of life as judged by users and beneficiaries more inclusion
lower risk on exclusion participation of the user transition from institutional to
community based care
Potential wider effects
Promoting social and health equality sustainability new skills and jobs
increased social rights affordability of adequate and high quality health and long-
term care promotion of equality and non-discrimination equal access to adequate
provision
Transferability of innovations between national contexts
29
Appendix 2 levels of innovation identified within INNOSERV Work Package 2
literature review
Organizational level (policy organizational sectors)
New social services designed to face new needs or unmet needs
Search for new solutions to old needs new mechanisms or practices introduced in
preexisting
social services
to improve access to social services (ie more information increased
professionalism in
social work sector)
to guarantee entitlements (rights) for specific groups or minorities
to satisfy the demand for social services in a more complete and broad way
(holistic
approach)
to guarantee more participation and inclusion of citizens
New and increased Cross-Sectoral social services
Cross-Sectoral social services (ie teaching art to children while helping their mothers
for
job seeking and offering jobs for young artists)
Integrated care practices
Tearing down walls between sectors and the role of informal care
Sharing of knowledge
Better integration of Health and Social sector services
Territory based social services that contribute to the creation of training and job
opportunities for disadvantaged people
Solidarity-based social services
Social mediation for impaired and weakened people
Easy access to housing for poor families
New interfaces with clients
Logic(s) of service Self help or mutual aid logic Social care logic Multi-stakeholders
logic
Social movements logic
The development of the self-help sector
Actors New organizations (Cooperative society for social service provision ndashSCOP
Cooperative society as social enterprise with userrsquos involvement ndashSCIC)
New legal forms within structured public frameworks (Italy social cooperatives)
New provider organizations and existing organisations refashioned by new dynamics
New roles and relations among actors
New private organizations for profit and non-profit
Management style in the organization
Regulatory and legislative level
New architecture of the provision system
Socially responsible public contracts and social clauses (outsourcing)
Adherence to EU standards in transitional economies
Impact on institutional framework that shape innovation in social services
New arrangement between one or more government agencies andor external
organization
Organizational level ndash Connection and Cooperation (governance and partnership)
New networks and social movements established in order to design deliver and
finance
social services
Cooperation between sectors actors and different forms of provision
Cooperation between local actors
Increasing communication responsiveness
30
Utilizing connectivity and interdependencies
Modification of organizational systems (models of governance work organisation
number
of involved stakeholders in governance)
Public sector and local authorities as promoters of innovation and promoters of
crosssectoral
policy strategies
Third sector and user as promoters of innovation
Volunteer workers and initiatives launched by a group of citizens
Third sector and userrsquos engagement design (co-design and re-design services)
Joint decision process
Decision-making power not based on capital ownership
Employee and user driven innovation
Partnerships with users family carers and user organizations
Partnership between service users practitioners and academics
Community-based and participative health network in a local territory
Collaboration between public and volunteer organisations (NGOs) or between civil and
local
networks in collaboration with public organisations and social enterprises
New techniques for partnership building and functioning
Impact on social and power relations
Professional level (practitioners)
New practices in social work
Innovative tools (ie Theatre of the Oppressed) and the use of participated methods in
social
work (ie self-help group)
Networking
Individualised supports
New professional skills in social work
The use of informatics and new technologies in social work
Users
Participation and involvement of final users of services in designing delivering and
evaluating social services
Involvement of final users in promoting equality effectiveness and control and
adherence
to the needs of users
Conceptual Level (and value)
New models of society - Social goals participation user involvement community
benefit
New paradigms underlying a new social service concept or service delivery model (ie
new
inclusion paradigm active ageing)
Relationships and trust
Pursuing diversity
Better adjustment to usersrsquo needs more person centred support
More social services provision in less developed regions
New concept of accessibility of the service (ie for Roma families)
The concept of lsquoprogressive universalismrsquo
The Social Care Model
De-institutionalization and community care Improved home-based and community
services
Gender and diversity perspectives
Anti-discrimination and equality process
Increase of the level of recognition of social values objectives paradigms and goals
New models of interaction leading to social innovation processes
31
Public policy level (policy framework programs and social policies)
The new role of the system governance played by central (or local depending on
national
arrangements) government
Impact on public policies new public policy programme measure or intervention
Joint construction of a space for public action and redefinition of public governance
bodies
and methods
Innovative logics for public policies
Innovating the public sector
The new wide attention on anti stigma policies
E-government
Financial and economic sustainability level (and scaling-diffusion-transferability
of innovation)
New ways to overcome budgetary constraints
New approaches to acquire funding
The involvement of private investors
The introduction of special funds
The purchase of innovative practices by final users
Hybridization of resources (market redistribution and reciprocity resources)
New investment sources
Mobilising community resources taking full advantage of all endogenous resources
Improvement in efficiency and effectiveness
Financial and systemic sustainability Impact on the economy
Economic Environmental and Social Sustainability of Territory based social services
Financial tools necessary to territorial social initiatives and the way to unlock them
Capacity of spreading and diffusion
Evaluative level and attention for quality
Affordability availability and accessibility
New standards expected
New feedback loops from users and specialists
Social services of excellence as for quality efficiency and efficacy
New methods and creative tool-kits to strengthen and renew the quality of social care
services
Low-cost (for user) and high level quality of social services
Quality assurance moderation and accreditation mechanisms
New tools for monitoring social services - hearing all voices (users organizations
practioners staff family and friends)
Action research
Alternative economic and social indicators
Social impact and contribution of innovation in social services to social innovation and
social change ndash Assessment of innovation
Learning approach to evaluation ndash lsquoto learn from failuresrsquo
Developmental evaluation
Specifics for the Health sector
Disability from rehabilitation to integration and then to inclusion
Mental Health from segregation to inclusion and community care
HIV from segregationstigmatization to awareness campaigns for promoting self
protection
Innovation in the area of prevention of treatment and in the introduction of new
technologies
Emphasis on an inter-sectoral controlled and steered care in managed care models
replacement of the traditional insurance model
Integrated services
Technological progress
32
Specifics for the Education sector
Inclusive education
Inclusive education and training in collaboration with the civil society
Multicultural education
Integration of disciplines
Alternative schools non-regular schools and informal education
Link between formal and informal education
Community development based approaches
Connection between regular school and the system of social services
Experiential learning
Human rights education
Working lsquothrough relationshipsrsquo with children and young people
Problem based learning methodology
The lsquomedia educationrsquo The use of comics
ICT in schools
E-inclusion
Networks of schools
Improve supplement reinvent and transform learning
Sustained educational improvement
Learning Beyond the Classroom
Spreading a culture that values learning
More personalized approaches to learning
Using the web
Learning with and by not to and from
33
Appendix 3 analysis of social challenges and changes driving innovation
Welfare
Societal
change as
driving force
of innovation
in social
services
Meaning
description
Related
outcomesother
factors
Examples of innovative
responses
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
Empowerment self-
determination choice
The lsquoassertive userrsquo
Demand for more
individualised services of
better quality
Alternativecomplementary
providers
Personalisation
Co-production (new
userprofessional
relationships)
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demand on services
Potential for poor access
to services (from
communication
problems social
isolation)
Multiculturalism
Integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Declining female
caregiving
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
34
Increased demand for
services demand for
formal care
Continued
inequality
Continued
economic
inequality
unemployment
continued poverty
including child
poverty continued
institutionalisation
continued
inequality for
people with
disabilities ethnic
minorities gender
inequalities
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients
with complex
comorbidities increase
in certain diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing demand for
services Increasing
costsneed to make
limited resources go
further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
Decisions about value
marketization
Technological
development
Access to
information new
media technology
Facilitates self
determination increases
expectations and choice
population better
informed about
conditionsservicesright
s and less deferential
Users better able to
35
mobilise
Increased exclusion of
some groups with limited
access
New models of remote
care provision
Ability to exchange
information on quality
and experience
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Increasing costs
Decisions about value
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Organisational
change changing
management
styles
philosophies
Creating new
organisational
forms application
of more responsive
management
processes
performance
management
culture
Integration of
organisationsfunctions
new approaches to
lsquocommissioningrsquo of
organisationsservices
distortions caused by
lsquolocked inrsquo expenditures
(tertiary health care
residential care)
Decentralisation
deinstitutionalisation
marketization liberalisation
The lsquoenabling
statersquo Political
will fiscal space
Impact of financial
crisis competing
priorities for public
funds
Legacy of category-based
(not needs based) social
protection structural
transition
deindustrialisation
Health
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
EmpowermentSelf-
determination choice
Demand for more
individualised services of
better quality
Users better able to mobilise
Assertive lsquouserrsquo
knowledgeable patient
Alternativecomplimentary
providers
36
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demands on
services
Potential for poor access
to services (from
communication
problems social
isolation)
MulticulturalismTrained
health professionals
move to richer countries
integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Declining female
caregiving
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
Increased demand for
formal care services
Continued
inequalities
Unequal
distribution of
health risks and
health
outcomediseases
by socioeconomic
indicators
Unequal access to
care by social
status geography
gender and
ethnicity
Demographic Increase in
numbers of over
Increase in patients with
complex comorbidities
Increasing demand for care
Decisions about value Active
37
change 65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing costsneed to
make limited resources
go further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
ageing paradigm
Technological
development
Access to
information new
media technology
Self determination
expectations choice
population better
informed about
conditionsservicesright
s and less deferential
Ability to exchange
information on quality
and experience
New models of care provision
(eg telehealth care) new
health management systems
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Changing
management
stylesphilosophi
es
Application of
more responsive
management
processes
Decentralisation
deinstitutionalisation
marketization liberalisation
Lifestyle changes Increase in certain
diseases related to
obesity alcohol
and drug
Increasing
costsdemands for care
38
consumption and
stress diabetes
liver disease
anxiety and
depression
Education
Aspirations Rising expectations
by citizens for
better quality of
life
Self determination
choice consumerism
Education outside of formal
setting
Assertive user
Lifelong learningeducation
Migration Historical (post
colonial) migration
pan-EU migration
refugees
New needs for education
eg language and culture
Inequalities social
fragmentation
Social Roles Changing family
structure increase
in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
changing gender
roles rising
female
employment rates
Need to reconcile work
and family life
Parentingfamily skills
for vulnerable
parentsfamilies
Socialization of children
ndash social and emotional
deficits for children in
some environments
Work with families and
communities
Continued
inequalities
Inequality in
educational
accessattainment
by socioeconomic
status gender
people with
disabilities ethnic
minorities
Culture of failure
Promise to deliver social
mobility and economic
improvement
(Leadbeater and Wond
2010 pp 5-20)
Inclusive and multicultural
education
Differential support for
children from
lsquodisadvantagedrsquo
backgrounds
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients with
complex comorbidities
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
New group of older
39
learners
Technological
advance
Access to
information new
media technology
making learning
available in new
ways
Self determination
expectations choice
lsquoAssertive userrsquo
Increased exclusion of
some groups with limited
access
Changing
management
styles
philosophies
Community based models
Globalization Need to provide
educationtraining
which is suited to
modern knowledge
based global
economies
This report for the InnoServ project (grant agreement nr 290542) is supported
under the Socio-economic and Humanities Programme of FP7
Chris Hawker
Faculty of Health Sciences University of Southampton Building 67 University Road Highfield Campus Southampton SO17 1BJ
Tel +44 (0)23 8059 7968
Email CHawkersotonacuk
27
8 Appendices
Appendix 1 Summary of types and criteria of innovation used in Work Package
3 to identify practices
Identification of social service
Field(s) of service
Logic(s) of service
Self help or mutual aid logic Social care logic Multi-stakeholders logic Social
movements logic Combination
Activities of services delivered
Assistance for persons faced with personal challenges or crises (debt unemployment
drug addiction other) (Re)integration of persons into society (rehabilitation language
training for immigrants other) Services to the labour market (occupational training)
Social housing for disadvantaged groups Care (for the elderly children families )
Treatment and support of people with physical illnesses Treatment and support of
people with mental health problems Combination
Status of the provider organization
Public organization (governmental) Private organization ndash nonnot for profit Private
organization ndash profit Volunteer association Cooperative company or mutual company
Familyneighbourhood Civil society network Combination Other
Target group
Children Youngsters Elder people Unemployed people Poor people Immigrants
Disabled people People with chronic diseases ndash long-term health problems People with
acute or short term health problems No specific target group (eg territory-based social
services provision aiming at strengthen social ties) Combination Other
Size of the organization
Innovation
Type of innovation
New forms of organization resources hybridization new targeted actions new services
non-structural practices other
Innovative character
do the service practices appear to be something new in the field of social services
Origins of innovation
Supply side demand side broader operating factors
Impact on service performance
Effectiveness of service delivery
from user perspective cost effectivenesscapacity building sustainability of
innovation
Quality of provision
28
Socialization quality of life as judged by users and beneficiaries more inclusion
lower risk on exclusion participation of the user transition from institutional to
community based care
Potential wider effects
Promoting social and health equality sustainability new skills and jobs
increased social rights affordability of adequate and high quality health and long-
term care promotion of equality and non-discrimination equal access to adequate
provision
Transferability of innovations between national contexts
29
Appendix 2 levels of innovation identified within INNOSERV Work Package 2
literature review
Organizational level (policy organizational sectors)
New social services designed to face new needs or unmet needs
Search for new solutions to old needs new mechanisms or practices introduced in
preexisting
social services
to improve access to social services (ie more information increased
professionalism in
social work sector)
to guarantee entitlements (rights) for specific groups or minorities
to satisfy the demand for social services in a more complete and broad way
(holistic
approach)
to guarantee more participation and inclusion of citizens
New and increased Cross-Sectoral social services
Cross-Sectoral social services (ie teaching art to children while helping their mothers
for
job seeking and offering jobs for young artists)
Integrated care practices
Tearing down walls between sectors and the role of informal care
Sharing of knowledge
Better integration of Health and Social sector services
Territory based social services that contribute to the creation of training and job
opportunities for disadvantaged people
Solidarity-based social services
Social mediation for impaired and weakened people
Easy access to housing for poor families
New interfaces with clients
Logic(s) of service Self help or mutual aid logic Social care logic Multi-stakeholders
logic
Social movements logic
The development of the self-help sector
Actors New organizations (Cooperative society for social service provision ndashSCOP
Cooperative society as social enterprise with userrsquos involvement ndashSCIC)
New legal forms within structured public frameworks (Italy social cooperatives)
New provider organizations and existing organisations refashioned by new dynamics
New roles and relations among actors
New private organizations for profit and non-profit
Management style in the organization
Regulatory and legislative level
New architecture of the provision system
Socially responsible public contracts and social clauses (outsourcing)
Adherence to EU standards in transitional economies
Impact on institutional framework that shape innovation in social services
New arrangement between one or more government agencies andor external
organization
Organizational level ndash Connection and Cooperation (governance and partnership)
New networks and social movements established in order to design deliver and
finance
social services
Cooperation between sectors actors and different forms of provision
Cooperation between local actors
Increasing communication responsiveness
30
Utilizing connectivity and interdependencies
Modification of organizational systems (models of governance work organisation
number
of involved stakeholders in governance)
Public sector and local authorities as promoters of innovation and promoters of
crosssectoral
policy strategies
Third sector and user as promoters of innovation
Volunteer workers and initiatives launched by a group of citizens
Third sector and userrsquos engagement design (co-design and re-design services)
Joint decision process
Decision-making power not based on capital ownership
Employee and user driven innovation
Partnerships with users family carers and user organizations
Partnership between service users practitioners and academics
Community-based and participative health network in a local territory
Collaboration between public and volunteer organisations (NGOs) or between civil and
local
networks in collaboration with public organisations and social enterprises
New techniques for partnership building and functioning
Impact on social and power relations
Professional level (practitioners)
New practices in social work
Innovative tools (ie Theatre of the Oppressed) and the use of participated methods in
social
work (ie self-help group)
Networking
Individualised supports
New professional skills in social work
The use of informatics and new technologies in social work
Users
Participation and involvement of final users of services in designing delivering and
evaluating social services
Involvement of final users in promoting equality effectiveness and control and
adherence
to the needs of users
Conceptual Level (and value)
New models of society - Social goals participation user involvement community
benefit
New paradigms underlying a new social service concept or service delivery model (ie
new
inclusion paradigm active ageing)
Relationships and trust
Pursuing diversity
Better adjustment to usersrsquo needs more person centred support
More social services provision in less developed regions
New concept of accessibility of the service (ie for Roma families)
The concept of lsquoprogressive universalismrsquo
The Social Care Model
De-institutionalization and community care Improved home-based and community
services
Gender and diversity perspectives
Anti-discrimination and equality process
Increase of the level of recognition of social values objectives paradigms and goals
New models of interaction leading to social innovation processes
31
Public policy level (policy framework programs and social policies)
The new role of the system governance played by central (or local depending on
national
arrangements) government
Impact on public policies new public policy programme measure or intervention
Joint construction of a space for public action and redefinition of public governance
bodies
and methods
Innovative logics for public policies
Innovating the public sector
The new wide attention on anti stigma policies
E-government
Financial and economic sustainability level (and scaling-diffusion-transferability
of innovation)
New ways to overcome budgetary constraints
New approaches to acquire funding
The involvement of private investors
The introduction of special funds
The purchase of innovative practices by final users
Hybridization of resources (market redistribution and reciprocity resources)
New investment sources
Mobilising community resources taking full advantage of all endogenous resources
Improvement in efficiency and effectiveness
Financial and systemic sustainability Impact on the economy
Economic Environmental and Social Sustainability of Territory based social services
Financial tools necessary to territorial social initiatives and the way to unlock them
Capacity of spreading and diffusion
Evaluative level and attention for quality
Affordability availability and accessibility
New standards expected
New feedback loops from users and specialists
Social services of excellence as for quality efficiency and efficacy
New methods and creative tool-kits to strengthen and renew the quality of social care
services
Low-cost (for user) and high level quality of social services
Quality assurance moderation and accreditation mechanisms
New tools for monitoring social services - hearing all voices (users organizations
practioners staff family and friends)
Action research
Alternative economic and social indicators
Social impact and contribution of innovation in social services to social innovation and
social change ndash Assessment of innovation
Learning approach to evaluation ndash lsquoto learn from failuresrsquo
Developmental evaluation
Specifics for the Health sector
Disability from rehabilitation to integration and then to inclusion
Mental Health from segregation to inclusion and community care
HIV from segregationstigmatization to awareness campaigns for promoting self
protection
Innovation in the area of prevention of treatment and in the introduction of new
technologies
Emphasis on an inter-sectoral controlled and steered care in managed care models
replacement of the traditional insurance model
Integrated services
Technological progress
32
Specifics for the Education sector
Inclusive education
Inclusive education and training in collaboration with the civil society
Multicultural education
Integration of disciplines
Alternative schools non-regular schools and informal education
Link between formal and informal education
Community development based approaches
Connection between regular school and the system of social services
Experiential learning
Human rights education
Working lsquothrough relationshipsrsquo with children and young people
Problem based learning methodology
The lsquomedia educationrsquo The use of comics
ICT in schools
E-inclusion
Networks of schools
Improve supplement reinvent and transform learning
Sustained educational improvement
Learning Beyond the Classroom
Spreading a culture that values learning
More personalized approaches to learning
Using the web
Learning with and by not to and from
33
Appendix 3 analysis of social challenges and changes driving innovation
Welfare
Societal
change as
driving force
of innovation
in social
services
Meaning
description
Related
outcomesother
factors
Examples of innovative
responses
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
Empowerment self-
determination choice
The lsquoassertive userrsquo
Demand for more
individualised services of
better quality
Alternativecomplementary
providers
Personalisation
Co-production (new
userprofessional
relationships)
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demand on services
Potential for poor access
to services (from
communication
problems social
isolation)
Multiculturalism
Integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Declining female
caregiving
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
34
Increased demand for
services demand for
formal care
Continued
inequality
Continued
economic
inequality
unemployment
continued poverty
including child
poverty continued
institutionalisation
continued
inequality for
people with
disabilities ethnic
minorities gender
inequalities
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients
with complex
comorbidities increase
in certain diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing demand for
services Increasing
costsneed to make
limited resources go
further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
Decisions about value
marketization
Technological
development
Access to
information new
media technology
Facilitates self
determination increases
expectations and choice
population better
informed about
conditionsservicesright
s and less deferential
Users better able to
35
mobilise
Increased exclusion of
some groups with limited
access
New models of remote
care provision
Ability to exchange
information on quality
and experience
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Increasing costs
Decisions about value
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Organisational
change changing
management
styles
philosophies
Creating new
organisational
forms application
of more responsive
management
processes
performance
management
culture
Integration of
organisationsfunctions
new approaches to
lsquocommissioningrsquo of
organisationsservices
distortions caused by
lsquolocked inrsquo expenditures
(tertiary health care
residential care)
Decentralisation
deinstitutionalisation
marketization liberalisation
The lsquoenabling
statersquo Political
will fiscal space
Impact of financial
crisis competing
priorities for public
funds
Legacy of category-based
(not needs based) social
protection structural
transition
deindustrialisation
Health
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
EmpowermentSelf-
determination choice
Demand for more
individualised services of
better quality
Users better able to mobilise
Assertive lsquouserrsquo
knowledgeable patient
Alternativecomplimentary
providers
36
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demands on
services
Potential for poor access
to services (from
communication
problems social
isolation)
MulticulturalismTrained
health professionals
move to richer countries
integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Declining female
caregiving
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
Increased demand for
formal care services
Continued
inequalities
Unequal
distribution of
health risks and
health
outcomediseases
by socioeconomic
indicators
Unequal access to
care by social
status geography
gender and
ethnicity
Demographic Increase in
numbers of over
Increase in patients with
complex comorbidities
Increasing demand for care
Decisions about value Active
37
change 65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing costsneed to
make limited resources
go further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
ageing paradigm
Technological
development
Access to
information new
media technology
Self determination
expectations choice
population better
informed about
conditionsservicesright
s and less deferential
Ability to exchange
information on quality
and experience
New models of care provision
(eg telehealth care) new
health management systems
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Changing
management
stylesphilosophi
es
Application of
more responsive
management
processes
Decentralisation
deinstitutionalisation
marketization liberalisation
Lifestyle changes Increase in certain
diseases related to
obesity alcohol
and drug
Increasing
costsdemands for care
38
consumption and
stress diabetes
liver disease
anxiety and
depression
Education
Aspirations Rising expectations
by citizens for
better quality of
life
Self determination
choice consumerism
Education outside of formal
setting
Assertive user
Lifelong learningeducation
Migration Historical (post
colonial) migration
pan-EU migration
refugees
New needs for education
eg language and culture
Inequalities social
fragmentation
Social Roles Changing family
structure increase
in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
changing gender
roles rising
female
employment rates
Need to reconcile work
and family life
Parentingfamily skills
for vulnerable
parentsfamilies
Socialization of children
ndash social and emotional
deficits for children in
some environments
Work with families and
communities
Continued
inequalities
Inequality in
educational
accessattainment
by socioeconomic
status gender
people with
disabilities ethnic
minorities
Culture of failure
Promise to deliver social
mobility and economic
improvement
(Leadbeater and Wond
2010 pp 5-20)
Inclusive and multicultural
education
Differential support for
children from
lsquodisadvantagedrsquo
backgrounds
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients with
complex comorbidities
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
New group of older
39
learners
Technological
advance
Access to
information new
media technology
making learning
available in new
ways
Self determination
expectations choice
lsquoAssertive userrsquo
Increased exclusion of
some groups with limited
access
Changing
management
styles
philosophies
Community based models
Globalization Need to provide
educationtraining
which is suited to
modern knowledge
based global
economies
This report for the InnoServ project (grant agreement nr 290542) is supported
under the Socio-economic and Humanities Programme of FP7
Chris Hawker
Faculty of Health Sciences University of Southampton Building 67 University Road Highfield Campus Southampton SO17 1BJ
Tel +44 (0)23 8059 7968
Email CHawkersotonacuk
28
Socialization quality of life as judged by users and beneficiaries more inclusion
lower risk on exclusion participation of the user transition from institutional to
community based care
Potential wider effects
Promoting social and health equality sustainability new skills and jobs
increased social rights affordability of adequate and high quality health and long-
term care promotion of equality and non-discrimination equal access to adequate
provision
Transferability of innovations between national contexts
29
Appendix 2 levels of innovation identified within INNOSERV Work Package 2
literature review
Organizational level (policy organizational sectors)
New social services designed to face new needs or unmet needs
Search for new solutions to old needs new mechanisms or practices introduced in
preexisting
social services
to improve access to social services (ie more information increased
professionalism in
social work sector)
to guarantee entitlements (rights) for specific groups or minorities
to satisfy the demand for social services in a more complete and broad way
(holistic
approach)
to guarantee more participation and inclusion of citizens
New and increased Cross-Sectoral social services
Cross-Sectoral social services (ie teaching art to children while helping their mothers
for
job seeking and offering jobs for young artists)
Integrated care practices
Tearing down walls between sectors and the role of informal care
Sharing of knowledge
Better integration of Health and Social sector services
Territory based social services that contribute to the creation of training and job
opportunities for disadvantaged people
Solidarity-based social services
Social mediation for impaired and weakened people
Easy access to housing for poor families
New interfaces with clients
Logic(s) of service Self help or mutual aid logic Social care logic Multi-stakeholders
logic
Social movements logic
The development of the self-help sector
Actors New organizations (Cooperative society for social service provision ndashSCOP
Cooperative society as social enterprise with userrsquos involvement ndashSCIC)
New legal forms within structured public frameworks (Italy social cooperatives)
New provider organizations and existing organisations refashioned by new dynamics
New roles and relations among actors
New private organizations for profit and non-profit
Management style in the organization
Regulatory and legislative level
New architecture of the provision system
Socially responsible public contracts and social clauses (outsourcing)
Adherence to EU standards in transitional economies
Impact on institutional framework that shape innovation in social services
New arrangement between one or more government agencies andor external
organization
Organizational level ndash Connection and Cooperation (governance and partnership)
New networks and social movements established in order to design deliver and
finance
social services
Cooperation between sectors actors and different forms of provision
Cooperation between local actors
Increasing communication responsiveness
30
Utilizing connectivity and interdependencies
Modification of organizational systems (models of governance work organisation
number
of involved stakeholders in governance)
Public sector and local authorities as promoters of innovation and promoters of
crosssectoral
policy strategies
Third sector and user as promoters of innovation
Volunteer workers and initiatives launched by a group of citizens
Third sector and userrsquos engagement design (co-design and re-design services)
Joint decision process
Decision-making power not based on capital ownership
Employee and user driven innovation
Partnerships with users family carers and user organizations
Partnership between service users practitioners and academics
Community-based and participative health network in a local territory
Collaboration between public and volunteer organisations (NGOs) or between civil and
local
networks in collaboration with public organisations and social enterprises
New techniques for partnership building and functioning
Impact on social and power relations
Professional level (practitioners)
New practices in social work
Innovative tools (ie Theatre of the Oppressed) and the use of participated methods in
social
work (ie self-help group)
Networking
Individualised supports
New professional skills in social work
The use of informatics and new technologies in social work
Users
Participation and involvement of final users of services in designing delivering and
evaluating social services
Involvement of final users in promoting equality effectiveness and control and
adherence
to the needs of users
Conceptual Level (and value)
New models of society - Social goals participation user involvement community
benefit
New paradigms underlying a new social service concept or service delivery model (ie
new
inclusion paradigm active ageing)
Relationships and trust
Pursuing diversity
Better adjustment to usersrsquo needs more person centred support
More social services provision in less developed regions
New concept of accessibility of the service (ie for Roma families)
The concept of lsquoprogressive universalismrsquo
The Social Care Model
De-institutionalization and community care Improved home-based and community
services
Gender and diversity perspectives
Anti-discrimination and equality process
Increase of the level of recognition of social values objectives paradigms and goals
New models of interaction leading to social innovation processes
31
Public policy level (policy framework programs and social policies)
The new role of the system governance played by central (or local depending on
national
arrangements) government
Impact on public policies new public policy programme measure or intervention
Joint construction of a space for public action and redefinition of public governance
bodies
and methods
Innovative logics for public policies
Innovating the public sector
The new wide attention on anti stigma policies
E-government
Financial and economic sustainability level (and scaling-diffusion-transferability
of innovation)
New ways to overcome budgetary constraints
New approaches to acquire funding
The involvement of private investors
The introduction of special funds
The purchase of innovative practices by final users
Hybridization of resources (market redistribution and reciprocity resources)
New investment sources
Mobilising community resources taking full advantage of all endogenous resources
Improvement in efficiency and effectiveness
Financial and systemic sustainability Impact on the economy
Economic Environmental and Social Sustainability of Territory based social services
Financial tools necessary to territorial social initiatives and the way to unlock them
Capacity of spreading and diffusion
Evaluative level and attention for quality
Affordability availability and accessibility
New standards expected
New feedback loops from users and specialists
Social services of excellence as for quality efficiency and efficacy
New methods and creative tool-kits to strengthen and renew the quality of social care
services
Low-cost (for user) and high level quality of social services
Quality assurance moderation and accreditation mechanisms
New tools for monitoring social services - hearing all voices (users organizations
practioners staff family and friends)
Action research
Alternative economic and social indicators
Social impact and contribution of innovation in social services to social innovation and
social change ndash Assessment of innovation
Learning approach to evaluation ndash lsquoto learn from failuresrsquo
Developmental evaluation
Specifics for the Health sector
Disability from rehabilitation to integration and then to inclusion
Mental Health from segregation to inclusion and community care
HIV from segregationstigmatization to awareness campaigns for promoting self
protection
Innovation in the area of prevention of treatment and in the introduction of new
technologies
Emphasis on an inter-sectoral controlled and steered care in managed care models
replacement of the traditional insurance model
Integrated services
Technological progress
32
Specifics for the Education sector
Inclusive education
Inclusive education and training in collaboration with the civil society
Multicultural education
Integration of disciplines
Alternative schools non-regular schools and informal education
Link between formal and informal education
Community development based approaches
Connection between regular school and the system of social services
Experiential learning
Human rights education
Working lsquothrough relationshipsrsquo with children and young people
Problem based learning methodology
The lsquomedia educationrsquo The use of comics
ICT in schools
E-inclusion
Networks of schools
Improve supplement reinvent and transform learning
Sustained educational improvement
Learning Beyond the Classroom
Spreading a culture that values learning
More personalized approaches to learning
Using the web
Learning with and by not to and from
33
Appendix 3 analysis of social challenges and changes driving innovation
Welfare
Societal
change as
driving force
of innovation
in social
services
Meaning
description
Related
outcomesother
factors
Examples of innovative
responses
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
Empowerment self-
determination choice
The lsquoassertive userrsquo
Demand for more
individualised services of
better quality
Alternativecomplementary
providers
Personalisation
Co-production (new
userprofessional
relationships)
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demand on services
Potential for poor access
to services (from
communication
problems social
isolation)
Multiculturalism
Integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Declining female
caregiving
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
34
Increased demand for
services demand for
formal care
Continued
inequality
Continued
economic
inequality
unemployment
continued poverty
including child
poverty continued
institutionalisation
continued
inequality for
people with
disabilities ethnic
minorities gender
inequalities
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients
with complex
comorbidities increase
in certain diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing demand for
services Increasing
costsneed to make
limited resources go
further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
Decisions about value
marketization
Technological
development
Access to
information new
media technology
Facilitates self
determination increases
expectations and choice
population better
informed about
conditionsservicesright
s and less deferential
Users better able to
35
mobilise
Increased exclusion of
some groups with limited
access
New models of remote
care provision
Ability to exchange
information on quality
and experience
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Increasing costs
Decisions about value
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Organisational
change changing
management
styles
philosophies
Creating new
organisational
forms application
of more responsive
management
processes
performance
management
culture
Integration of
organisationsfunctions
new approaches to
lsquocommissioningrsquo of
organisationsservices
distortions caused by
lsquolocked inrsquo expenditures
(tertiary health care
residential care)
Decentralisation
deinstitutionalisation
marketization liberalisation
The lsquoenabling
statersquo Political
will fiscal space
Impact of financial
crisis competing
priorities for public
funds
Legacy of category-based
(not needs based) social
protection structural
transition
deindustrialisation
Health
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
EmpowermentSelf-
determination choice
Demand for more
individualised services of
better quality
Users better able to mobilise
Assertive lsquouserrsquo
knowledgeable patient
Alternativecomplimentary
providers
36
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demands on
services
Potential for poor access
to services (from
communication
problems social
isolation)
MulticulturalismTrained
health professionals
move to richer countries
integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Declining female
caregiving
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
Increased demand for
formal care services
Continued
inequalities
Unequal
distribution of
health risks and
health
outcomediseases
by socioeconomic
indicators
Unequal access to
care by social
status geography
gender and
ethnicity
Demographic Increase in
numbers of over
Increase in patients with
complex comorbidities
Increasing demand for care
Decisions about value Active
37
change 65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing costsneed to
make limited resources
go further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
ageing paradigm
Technological
development
Access to
information new
media technology
Self determination
expectations choice
population better
informed about
conditionsservicesright
s and less deferential
Ability to exchange
information on quality
and experience
New models of care provision
(eg telehealth care) new
health management systems
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Changing
management
stylesphilosophi
es
Application of
more responsive
management
processes
Decentralisation
deinstitutionalisation
marketization liberalisation
Lifestyle changes Increase in certain
diseases related to
obesity alcohol
and drug
Increasing
costsdemands for care
38
consumption and
stress diabetes
liver disease
anxiety and
depression
Education
Aspirations Rising expectations
by citizens for
better quality of
life
Self determination
choice consumerism
Education outside of formal
setting
Assertive user
Lifelong learningeducation
Migration Historical (post
colonial) migration
pan-EU migration
refugees
New needs for education
eg language and culture
Inequalities social
fragmentation
Social Roles Changing family
structure increase
in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
changing gender
roles rising
female
employment rates
Need to reconcile work
and family life
Parentingfamily skills
for vulnerable
parentsfamilies
Socialization of children
ndash social and emotional
deficits for children in
some environments
Work with families and
communities
Continued
inequalities
Inequality in
educational
accessattainment
by socioeconomic
status gender
people with
disabilities ethnic
minorities
Culture of failure
Promise to deliver social
mobility and economic
improvement
(Leadbeater and Wond
2010 pp 5-20)
Inclusive and multicultural
education
Differential support for
children from
lsquodisadvantagedrsquo
backgrounds
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients with
complex comorbidities
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
New group of older
39
learners
Technological
advance
Access to
information new
media technology
making learning
available in new
ways
Self determination
expectations choice
lsquoAssertive userrsquo
Increased exclusion of
some groups with limited
access
Changing
management
styles
philosophies
Community based models
Globalization Need to provide
educationtraining
which is suited to
modern knowledge
based global
economies
This report for the InnoServ project (grant agreement nr 290542) is supported
under the Socio-economic and Humanities Programme of FP7
Chris Hawker
Faculty of Health Sciences University of Southampton Building 67 University Road Highfield Campus Southampton SO17 1BJ
Tel +44 (0)23 8059 7968
Email CHawkersotonacuk
29
Appendix 2 levels of innovation identified within INNOSERV Work Package 2
literature review
Organizational level (policy organizational sectors)
New social services designed to face new needs or unmet needs
Search for new solutions to old needs new mechanisms or practices introduced in
preexisting
social services
to improve access to social services (ie more information increased
professionalism in
social work sector)
to guarantee entitlements (rights) for specific groups or minorities
to satisfy the demand for social services in a more complete and broad way
(holistic
approach)
to guarantee more participation and inclusion of citizens
New and increased Cross-Sectoral social services
Cross-Sectoral social services (ie teaching art to children while helping their mothers
for
job seeking and offering jobs for young artists)
Integrated care practices
Tearing down walls between sectors and the role of informal care
Sharing of knowledge
Better integration of Health and Social sector services
Territory based social services that contribute to the creation of training and job
opportunities for disadvantaged people
Solidarity-based social services
Social mediation for impaired and weakened people
Easy access to housing for poor families
New interfaces with clients
Logic(s) of service Self help or mutual aid logic Social care logic Multi-stakeholders
logic
Social movements logic
The development of the self-help sector
Actors New organizations (Cooperative society for social service provision ndashSCOP
Cooperative society as social enterprise with userrsquos involvement ndashSCIC)
New legal forms within structured public frameworks (Italy social cooperatives)
New provider organizations and existing organisations refashioned by new dynamics
New roles and relations among actors
New private organizations for profit and non-profit
Management style in the organization
Regulatory and legislative level
New architecture of the provision system
Socially responsible public contracts and social clauses (outsourcing)
Adherence to EU standards in transitional economies
Impact on institutional framework that shape innovation in social services
New arrangement between one or more government agencies andor external
organization
Organizational level ndash Connection and Cooperation (governance and partnership)
New networks and social movements established in order to design deliver and
finance
social services
Cooperation between sectors actors and different forms of provision
Cooperation between local actors
Increasing communication responsiveness
30
Utilizing connectivity and interdependencies
Modification of organizational systems (models of governance work organisation
number
of involved stakeholders in governance)
Public sector and local authorities as promoters of innovation and promoters of
crosssectoral
policy strategies
Third sector and user as promoters of innovation
Volunteer workers and initiatives launched by a group of citizens
Third sector and userrsquos engagement design (co-design and re-design services)
Joint decision process
Decision-making power not based on capital ownership
Employee and user driven innovation
Partnerships with users family carers and user organizations
Partnership between service users practitioners and academics
Community-based and participative health network in a local territory
Collaboration between public and volunteer organisations (NGOs) or between civil and
local
networks in collaboration with public organisations and social enterprises
New techniques for partnership building and functioning
Impact on social and power relations
Professional level (practitioners)
New practices in social work
Innovative tools (ie Theatre of the Oppressed) and the use of participated methods in
social
work (ie self-help group)
Networking
Individualised supports
New professional skills in social work
The use of informatics and new technologies in social work
Users
Participation and involvement of final users of services in designing delivering and
evaluating social services
Involvement of final users in promoting equality effectiveness and control and
adherence
to the needs of users
Conceptual Level (and value)
New models of society - Social goals participation user involvement community
benefit
New paradigms underlying a new social service concept or service delivery model (ie
new
inclusion paradigm active ageing)
Relationships and trust
Pursuing diversity
Better adjustment to usersrsquo needs more person centred support
More social services provision in less developed regions
New concept of accessibility of the service (ie for Roma families)
The concept of lsquoprogressive universalismrsquo
The Social Care Model
De-institutionalization and community care Improved home-based and community
services
Gender and diversity perspectives
Anti-discrimination and equality process
Increase of the level of recognition of social values objectives paradigms and goals
New models of interaction leading to social innovation processes
31
Public policy level (policy framework programs and social policies)
The new role of the system governance played by central (or local depending on
national
arrangements) government
Impact on public policies new public policy programme measure or intervention
Joint construction of a space for public action and redefinition of public governance
bodies
and methods
Innovative logics for public policies
Innovating the public sector
The new wide attention on anti stigma policies
E-government
Financial and economic sustainability level (and scaling-diffusion-transferability
of innovation)
New ways to overcome budgetary constraints
New approaches to acquire funding
The involvement of private investors
The introduction of special funds
The purchase of innovative practices by final users
Hybridization of resources (market redistribution and reciprocity resources)
New investment sources
Mobilising community resources taking full advantage of all endogenous resources
Improvement in efficiency and effectiveness
Financial and systemic sustainability Impact on the economy
Economic Environmental and Social Sustainability of Territory based social services
Financial tools necessary to territorial social initiatives and the way to unlock them
Capacity of spreading and diffusion
Evaluative level and attention for quality
Affordability availability and accessibility
New standards expected
New feedback loops from users and specialists
Social services of excellence as for quality efficiency and efficacy
New methods and creative tool-kits to strengthen and renew the quality of social care
services
Low-cost (for user) and high level quality of social services
Quality assurance moderation and accreditation mechanisms
New tools for monitoring social services - hearing all voices (users organizations
practioners staff family and friends)
Action research
Alternative economic and social indicators
Social impact and contribution of innovation in social services to social innovation and
social change ndash Assessment of innovation
Learning approach to evaluation ndash lsquoto learn from failuresrsquo
Developmental evaluation
Specifics for the Health sector
Disability from rehabilitation to integration and then to inclusion
Mental Health from segregation to inclusion and community care
HIV from segregationstigmatization to awareness campaigns for promoting self
protection
Innovation in the area of prevention of treatment and in the introduction of new
technologies
Emphasis on an inter-sectoral controlled and steered care in managed care models
replacement of the traditional insurance model
Integrated services
Technological progress
32
Specifics for the Education sector
Inclusive education
Inclusive education and training in collaboration with the civil society
Multicultural education
Integration of disciplines
Alternative schools non-regular schools and informal education
Link between formal and informal education
Community development based approaches
Connection between regular school and the system of social services
Experiential learning
Human rights education
Working lsquothrough relationshipsrsquo with children and young people
Problem based learning methodology
The lsquomedia educationrsquo The use of comics
ICT in schools
E-inclusion
Networks of schools
Improve supplement reinvent and transform learning
Sustained educational improvement
Learning Beyond the Classroom
Spreading a culture that values learning
More personalized approaches to learning
Using the web
Learning with and by not to and from
33
Appendix 3 analysis of social challenges and changes driving innovation
Welfare
Societal
change as
driving force
of innovation
in social
services
Meaning
description
Related
outcomesother
factors
Examples of innovative
responses
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
Empowerment self-
determination choice
The lsquoassertive userrsquo
Demand for more
individualised services of
better quality
Alternativecomplementary
providers
Personalisation
Co-production (new
userprofessional
relationships)
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demand on services
Potential for poor access
to services (from
communication
problems social
isolation)
Multiculturalism
Integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Declining female
caregiving
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
34
Increased demand for
services demand for
formal care
Continued
inequality
Continued
economic
inequality
unemployment
continued poverty
including child
poverty continued
institutionalisation
continued
inequality for
people with
disabilities ethnic
minorities gender
inequalities
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients
with complex
comorbidities increase
in certain diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing demand for
services Increasing
costsneed to make
limited resources go
further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
Decisions about value
marketization
Technological
development
Access to
information new
media technology
Facilitates self
determination increases
expectations and choice
population better
informed about
conditionsservicesright
s and less deferential
Users better able to
35
mobilise
Increased exclusion of
some groups with limited
access
New models of remote
care provision
Ability to exchange
information on quality
and experience
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Increasing costs
Decisions about value
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Organisational
change changing
management
styles
philosophies
Creating new
organisational
forms application
of more responsive
management
processes
performance
management
culture
Integration of
organisationsfunctions
new approaches to
lsquocommissioningrsquo of
organisationsservices
distortions caused by
lsquolocked inrsquo expenditures
(tertiary health care
residential care)
Decentralisation
deinstitutionalisation
marketization liberalisation
The lsquoenabling
statersquo Political
will fiscal space
Impact of financial
crisis competing
priorities for public
funds
Legacy of category-based
(not needs based) social
protection structural
transition
deindustrialisation
Health
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
EmpowermentSelf-
determination choice
Demand for more
individualised services of
better quality
Users better able to mobilise
Assertive lsquouserrsquo
knowledgeable patient
Alternativecomplimentary
providers
36
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demands on
services
Potential for poor access
to services (from
communication
problems social
isolation)
MulticulturalismTrained
health professionals
move to richer countries
integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Declining female
caregiving
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
Increased demand for
formal care services
Continued
inequalities
Unequal
distribution of
health risks and
health
outcomediseases
by socioeconomic
indicators
Unequal access to
care by social
status geography
gender and
ethnicity
Demographic Increase in
numbers of over
Increase in patients with
complex comorbidities
Increasing demand for care
Decisions about value Active
37
change 65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing costsneed to
make limited resources
go further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
ageing paradigm
Technological
development
Access to
information new
media technology
Self determination
expectations choice
population better
informed about
conditionsservicesright
s and less deferential
Ability to exchange
information on quality
and experience
New models of care provision
(eg telehealth care) new
health management systems
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Changing
management
stylesphilosophi
es
Application of
more responsive
management
processes
Decentralisation
deinstitutionalisation
marketization liberalisation
Lifestyle changes Increase in certain
diseases related to
obesity alcohol
and drug
Increasing
costsdemands for care
38
consumption and
stress diabetes
liver disease
anxiety and
depression
Education
Aspirations Rising expectations
by citizens for
better quality of
life
Self determination
choice consumerism
Education outside of formal
setting
Assertive user
Lifelong learningeducation
Migration Historical (post
colonial) migration
pan-EU migration
refugees
New needs for education
eg language and culture
Inequalities social
fragmentation
Social Roles Changing family
structure increase
in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
changing gender
roles rising
female
employment rates
Need to reconcile work
and family life
Parentingfamily skills
for vulnerable
parentsfamilies
Socialization of children
ndash social and emotional
deficits for children in
some environments
Work with families and
communities
Continued
inequalities
Inequality in
educational
accessattainment
by socioeconomic
status gender
people with
disabilities ethnic
minorities
Culture of failure
Promise to deliver social
mobility and economic
improvement
(Leadbeater and Wond
2010 pp 5-20)
Inclusive and multicultural
education
Differential support for
children from
lsquodisadvantagedrsquo
backgrounds
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients with
complex comorbidities
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
New group of older
39
learners
Technological
advance
Access to
information new
media technology
making learning
available in new
ways
Self determination
expectations choice
lsquoAssertive userrsquo
Increased exclusion of
some groups with limited
access
Changing
management
styles
philosophies
Community based models
Globalization Need to provide
educationtraining
which is suited to
modern knowledge
based global
economies
This report for the InnoServ project (grant agreement nr 290542) is supported
under the Socio-economic and Humanities Programme of FP7
Chris Hawker
Faculty of Health Sciences University of Southampton Building 67 University Road Highfield Campus Southampton SO17 1BJ
Tel +44 (0)23 8059 7968
Email CHawkersotonacuk
30
Utilizing connectivity and interdependencies
Modification of organizational systems (models of governance work organisation
number
of involved stakeholders in governance)
Public sector and local authorities as promoters of innovation and promoters of
crosssectoral
policy strategies
Third sector and user as promoters of innovation
Volunteer workers and initiatives launched by a group of citizens
Third sector and userrsquos engagement design (co-design and re-design services)
Joint decision process
Decision-making power not based on capital ownership
Employee and user driven innovation
Partnerships with users family carers and user organizations
Partnership between service users practitioners and academics
Community-based and participative health network in a local territory
Collaboration between public and volunteer organisations (NGOs) or between civil and
local
networks in collaboration with public organisations and social enterprises
New techniques for partnership building and functioning
Impact on social and power relations
Professional level (practitioners)
New practices in social work
Innovative tools (ie Theatre of the Oppressed) and the use of participated methods in
social
work (ie self-help group)
Networking
Individualised supports
New professional skills in social work
The use of informatics and new technologies in social work
Users
Participation and involvement of final users of services in designing delivering and
evaluating social services
Involvement of final users in promoting equality effectiveness and control and
adherence
to the needs of users
Conceptual Level (and value)
New models of society - Social goals participation user involvement community
benefit
New paradigms underlying a new social service concept or service delivery model (ie
new
inclusion paradigm active ageing)
Relationships and trust
Pursuing diversity
Better adjustment to usersrsquo needs more person centred support
More social services provision in less developed regions
New concept of accessibility of the service (ie for Roma families)
The concept of lsquoprogressive universalismrsquo
The Social Care Model
De-institutionalization and community care Improved home-based and community
services
Gender and diversity perspectives
Anti-discrimination and equality process
Increase of the level of recognition of social values objectives paradigms and goals
New models of interaction leading to social innovation processes
31
Public policy level (policy framework programs and social policies)
The new role of the system governance played by central (or local depending on
national
arrangements) government
Impact on public policies new public policy programme measure or intervention
Joint construction of a space for public action and redefinition of public governance
bodies
and methods
Innovative logics for public policies
Innovating the public sector
The new wide attention on anti stigma policies
E-government
Financial and economic sustainability level (and scaling-diffusion-transferability
of innovation)
New ways to overcome budgetary constraints
New approaches to acquire funding
The involvement of private investors
The introduction of special funds
The purchase of innovative practices by final users
Hybridization of resources (market redistribution and reciprocity resources)
New investment sources
Mobilising community resources taking full advantage of all endogenous resources
Improvement in efficiency and effectiveness
Financial and systemic sustainability Impact on the economy
Economic Environmental and Social Sustainability of Territory based social services
Financial tools necessary to territorial social initiatives and the way to unlock them
Capacity of spreading and diffusion
Evaluative level and attention for quality
Affordability availability and accessibility
New standards expected
New feedback loops from users and specialists
Social services of excellence as for quality efficiency and efficacy
New methods and creative tool-kits to strengthen and renew the quality of social care
services
Low-cost (for user) and high level quality of social services
Quality assurance moderation and accreditation mechanisms
New tools for monitoring social services - hearing all voices (users organizations
practioners staff family and friends)
Action research
Alternative economic and social indicators
Social impact and contribution of innovation in social services to social innovation and
social change ndash Assessment of innovation
Learning approach to evaluation ndash lsquoto learn from failuresrsquo
Developmental evaluation
Specifics for the Health sector
Disability from rehabilitation to integration and then to inclusion
Mental Health from segregation to inclusion and community care
HIV from segregationstigmatization to awareness campaigns for promoting self
protection
Innovation in the area of prevention of treatment and in the introduction of new
technologies
Emphasis on an inter-sectoral controlled and steered care in managed care models
replacement of the traditional insurance model
Integrated services
Technological progress
32
Specifics for the Education sector
Inclusive education
Inclusive education and training in collaboration with the civil society
Multicultural education
Integration of disciplines
Alternative schools non-regular schools and informal education
Link between formal and informal education
Community development based approaches
Connection between regular school and the system of social services
Experiential learning
Human rights education
Working lsquothrough relationshipsrsquo with children and young people
Problem based learning methodology
The lsquomedia educationrsquo The use of comics
ICT in schools
E-inclusion
Networks of schools
Improve supplement reinvent and transform learning
Sustained educational improvement
Learning Beyond the Classroom
Spreading a culture that values learning
More personalized approaches to learning
Using the web
Learning with and by not to and from
33
Appendix 3 analysis of social challenges and changes driving innovation
Welfare
Societal
change as
driving force
of innovation
in social
services
Meaning
description
Related
outcomesother
factors
Examples of innovative
responses
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
Empowerment self-
determination choice
The lsquoassertive userrsquo
Demand for more
individualised services of
better quality
Alternativecomplementary
providers
Personalisation
Co-production (new
userprofessional
relationships)
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demand on services
Potential for poor access
to services (from
communication
problems social
isolation)
Multiculturalism
Integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Declining female
caregiving
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
34
Increased demand for
services demand for
formal care
Continued
inequality
Continued
economic
inequality
unemployment
continued poverty
including child
poverty continued
institutionalisation
continued
inequality for
people with
disabilities ethnic
minorities gender
inequalities
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients
with complex
comorbidities increase
in certain diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing demand for
services Increasing
costsneed to make
limited resources go
further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
Decisions about value
marketization
Technological
development
Access to
information new
media technology
Facilitates self
determination increases
expectations and choice
population better
informed about
conditionsservicesright
s and less deferential
Users better able to
35
mobilise
Increased exclusion of
some groups with limited
access
New models of remote
care provision
Ability to exchange
information on quality
and experience
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Increasing costs
Decisions about value
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Organisational
change changing
management
styles
philosophies
Creating new
organisational
forms application
of more responsive
management
processes
performance
management
culture
Integration of
organisationsfunctions
new approaches to
lsquocommissioningrsquo of
organisationsservices
distortions caused by
lsquolocked inrsquo expenditures
(tertiary health care
residential care)
Decentralisation
deinstitutionalisation
marketization liberalisation
The lsquoenabling
statersquo Political
will fiscal space
Impact of financial
crisis competing
priorities for public
funds
Legacy of category-based
(not needs based) social
protection structural
transition
deindustrialisation
Health
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
EmpowermentSelf-
determination choice
Demand for more
individualised services of
better quality
Users better able to mobilise
Assertive lsquouserrsquo
knowledgeable patient
Alternativecomplimentary
providers
36
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demands on
services
Potential for poor access
to services (from
communication
problems social
isolation)
MulticulturalismTrained
health professionals
move to richer countries
integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Declining female
caregiving
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
Increased demand for
formal care services
Continued
inequalities
Unequal
distribution of
health risks and
health
outcomediseases
by socioeconomic
indicators
Unequal access to
care by social
status geography
gender and
ethnicity
Demographic Increase in
numbers of over
Increase in patients with
complex comorbidities
Increasing demand for care
Decisions about value Active
37
change 65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing costsneed to
make limited resources
go further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
ageing paradigm
Technological
development
Access to
information new
media technology
Self determination
expectations choice
population better
informed about
conditionsservicesright
s and less deferential
Ability to exchange
information on quality
and experience
New models of care provision
(eg telehealth care) new
health management systems
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Changing
management
stylesphilosophi
es
Application of
more responsive
management
processes
Decentralisation
deinstitutionalisation
marketization liberalisation
Lifestyle changes Increase in certain
diseases related to
obesity alcohol
and drug
Increasing
costsdemands for care
38
consumption and
stress diabetes
liver disease
anxiety and
depression
Education
Aspirations Rising expectations
by citizens for
better quality of
life
Self determination
choice consumerism
Education outside of formal
setting
Assertive user
Lifelong learningeducation
Migration Historical (post
colonial) migration
pan-EU migration
refugees
New needs for education
eg language and culture
Inequalities social
fragmentation
Social Roles Changing family
structure increase
in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
changing gender
roles rising
female
employment rates
Need to reconcile work
and family life
Parentingfamily skills
for vulnerable
parentsfamilies
Socialization of children
ndash social and emotional
deficits for children in
some environments
Work with families and
communities
Continued
inequalities
Inequality in
educational
accessattainment
by socioeconomic
status gender
people with
disabilities ethnic
minorities
Culture of failure
Promise to deliver social
mobility and economic
improvement
(Leadbeater and Wond
2010 pp 5-20)
Inclusive and multicultural
education
Differential support for
children from
lsquodisadvantagedrsquo
backgrounds
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients with
complex comorbidities
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
New group of older
39
learners
Technological
advance
Access to
information new
media technology
making learning
available in new
ways
Self determination
expectations choice
lsquoAssertive userrsquo
Increased exclusion of
some groups with limited
access
Changing
management
styles
philosophies
Community based models
Globalization Need to provide
educationtraining
which is suited to
modern knowledge
based global
economies
This report for the InnoServ project (grant agreement nr 290542) is supported
under the Socio-economic and Humanities Programme of FP7
Chris Hawker
Faculty of Health Sciences University of Southampton Building 67 University Road Highfield Campus Southampton SO17 1BJ
Tel +44 (0)23 8059 7968
Email CHawkersotonacuk
31
Public policy level (policy framework programs and social policies)
The new role of the system governance played by central (or local depending on
national
arrangements) government
Impact on public policies new public policy programme measure or intervention
Joint construction of a space for public action and redefinition of public governance
bodies
and methods
Innovative logics for public policies
Innovating the public sector
The new wide attention on anti stigma policies
E-government
Financial and economic sustainability level (and scaling-diffusion-transferability
of innovation)
New ways to overcome budgetary constraints
New approaches to acquire funding
The involvement of private investors
The introduction of special funds
The purchase of innovative practices by final users
Hybridization of resources (market redistribution and reciprocity resources)
New investment sources
Mobilising community resources taking full advantage of all endogenous resources
Improvement in efficiency and effectiveness
Financial and systemic sustainability Impact on the economy
Economic Environmental and Social Sustainability of Territory based social services
Financial tools necessary to territorial social initiatives and the way to unlock them
Capacity of spreading and diffusion
Evaluative level and attention for quality
Affordability availability and accessibility
New standards expected
New feedback loops from users and specialists
Social services of excellence as for quality efficiency and efficacy
New methods and creative tool-kits to strengthen and renew the quality of social care
services
Low-cost (for user) and high level quality of social services
Quality assurance moderation and accreditation mechanisms
New tools for monitoring social services - hearing all voices (users organizations
practioners staff family and friends)
Action research
Alternative economic and social indicators
Social impact and contribution of innovation in social services to social innovation and
social change ndash Assessment of innovation
Learning approach to evaluation ndash lsquoto learn from failuresrsquo
Developmental evaluation
Specifics for the Health sector
Disability from rehabilitation to integration and then to inclusion
Mental Health from segregation to inclusion and community care
HIV from segregationstigmatization to awareness campaigns for promoting self
protection
Innovation in the area of prevention of treatment and in the introduction of new
technologies
Emphasis on an inter-sectoral controlled and steered care in managed care models
replacement of the traditional insurance model
Integrated services
Technological progress
32
Specifics for the Education sector
Inclusive education
Inclusive education and training in collaboration with the civil society
Multicultural education
Integration of disciplines
Alternative schools non-regular schools and informal education
Link between formal and informal education
Community development based approaches
Connection between regular school and the system of social services
Experiential learning
Human rights education
Working lsquothrough relationshipsrsquo with children and young people
Problem based learning methodology
The lsquomedia educationrsquo The use of comics
ICT in schools
E-inclusion
Networks of schools
Improve supplement reinvent and transform learning
Sustained educational improvement
Learning Beyond the Classroom
Spreading a culture that values learning
More personalized approaches to learning
Using the web
Learning with and by not to and from
33
Appendix 3 analysis of social challenges and changes driving innovation
Welfare
Societal
change as
driving force
of innovation
in social
services
Meaning
description
Related
outcomesother
factors
Examples of innovative
responses
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
Empowerment self-
determination choice
The lsquoassertive userrsquo
Demand for more
individualised services of
better quality
Alternativecomplementary
providers
Personalisation
Co-production (new
userprofessional
relationships)
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demand on services
Potential for poor access
to services (from
communication
problems social
isolation)
Multiculturalism
Integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Declining female
caregiving
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
34
Increased demand for
services demand for
formal care
Continued
inequality
Continued
economic
inequality
unemployment
continued poverty
including child
poverty continued
institutionalisation
continued
inequality for
people with
disabilities ethnic
minorities gender
inequalities
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients
with complex
comorbidities increase
in certain diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing demand for
services Increasing
costsneed to make
limited resources go
further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
Decisions about value
marketization
Technological
development
Access to
information new
media technology
Facilitates self
determination increases
expectations and choice
population better
informed about
conditionsservicesright
s and less deferential
Users better able to
35
mobilise
Increased exclusion of
some groups with limited
access
New models of remote
care provision
Ability to exchange
information on quality
and experience
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Increasing costs
Decisions about value
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Organisational
change changing
management
styles
philosophies
Creating new
organisational
forms application
of more responsive
management
processes
performance
management
culture
Integration of
organisationsfunctions
new approaches to
lsquocommissioningrsquo of
organisationsservices
distortions caused by
lsquolocked inrsquo expenditures
(tertiary health care
residential care)
Decentralisation
deinstitutionalisation
marketization liberalisation
The lsquoenabling
statersquo Political
will fiscal space
Impact of financial
crisis competing
priorities for public
funds
Legacy of category-based
(not needs based) social
protection structural
transition
deindustrialisation
Health
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
EmpowermentSelf-
determination choice
Demand for more
individualised services of
better quality
Users better able to mobilise
Assertive lsquouserrsquo
knowledgeable patient
Alternativecomplimentary
providers
36
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demands on
services
Potential for poor access
to services (from
communication
problems social
isolation)
MulticulturalismTrained
health professionals
move to richer countries
integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Declining female
caregiving
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
Increased demand for
formal care services
Continued
inequalities
Unequal
distribution of
health risks and
health
outcomediseases
by socioeconomic
indicators
Unequal access to
care by social
status geography
gender and
ethnicity
Demographic Increase in
numbers of over
Increase in patients with
complex comorbidities
Increasing demand for care
Decisions about value Active
37
change 65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing costsneed to
make limited resources
go further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
ageing paradigm
Technological
development
Access to
information new
media technology
Self determination
expectations choice
population better
informed about
conditionsservicesright
s and less deferential
Ability to exchange
information on quality
and experience
New models of care provision
(eg telehealth care) new
health management systems
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Changing
management
stylesphilosophi
es
Application of
more responsive
management
processes
Decentralisation
deinstitutionalisation
marketization liberalisation
Lifestyle changes Increase in certain
diseases related to
obesity alcohol
and drug
Increasing
costsdemands for care
38
consumption and
stress diabetes
liver disease
anxiety and
depression
Education
Aspirations Rising expectations
by citizens for
better quality of
life
Self determination
choice consumerism
Education outside of formal
setting
Assertive user
Lifelong learningeducation
Migration Historical (post
colonial) migration
pan-EU migration
refugees
New needs for education
eg language and culture
Inequalities social
fragmentation
Social Roles Changing family
structure increase
in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
changing gender
roles rising
female
employment rates
Need to reconcile work
and family life
Parentingfamily skills
for vulnerable
parentsfamilies
Socialization of children
ndash social and emotional
deficits for children in
some environments
Work with families and
communities
Continued
inequalities
Inequality in
educational
accessattainment
by socioeconomic
status gender
people with
disabilities ethnic
minorities
Culture of failure
Promise to deliver social
mobility and economic
improvement
(Leadbeater and Wond
2010 pp 5-20)
Inclusive and multicultural
education
Differential support for
children from
lsquodisadvantagedrsquo
backgrounds
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients with
complex comorbidities
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
New group of older
39
learners
Technological
advance
Access to
information new
media technology
making learning
available in new
ways
Self determination
expectations choice
lsquoAssertive userrsquo
Increased exclusion of
some groups with limited
access
Changing
management
styles
philosophies
Community based models
Globalization Need to provide
educationtraining
which is suited to
modern knowledge
based global
economies
This report for the InnoServ project (grant agreement nr 290542) is supported
under the Socio-economic and Humanities Programme of FP7
Chris Hawker
Faculty of Health Sciences University of Southampton Building 67 University Road Highfield Campus Southampton SO17 1BJ
Tel +44 (0)23 8059 7968
Email CHawkersotonacuk
32
Specifics for the Education sector
Inclusive education
Inclusive education and training in collaboration with the civil society
Multicultural education
Integration of disciplines
Alternative schools non-regular schools and informal education
Link between formal and informal education
Community development based approaches
Connection between regular school and the system of social services
Experiential learning
Human rights education
Working lsquothrough relationshipsrsquo with children and young people
Problem based learning methodology
The lsquomedia educationrsquo The use of comics
ICT in schools
E-inclusion
Networks of schools
Improve supplement reinvent and transform learning
Sustained educational improvement
Learning Beyond the Classroom
Spreading a culture that values learning
More personalized approaches to learning
Using the web
Learning with and by not to and from
33
Appendix 3 analysis of social challenges and changes driving innovation
Welfare
Societal
change as
driving force
of innovation
in social
services
Meaning
description
Related
outcomesother
factors
Examples of innovative
responses
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
Empowerment self-
determination choice
The lsquoassertive userrsquo
Demand for more
individualised services of
better quality
Alternativecomplementary
providers
Personalisation
Co-production (new
userprofessional
relationships)
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demand on services
Potential for poor access
to services (from
communication
problems social
isolation)
Multiculturalism
Integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Declining female
caregiving
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
34
Increased demand for
services demand for
formal care
Continued
inequality
Continued
economic
inequality
unemployment
continued poverty
including child
poverty continued
institutionalisation
continued
inequality for
people with
disabilities ethnic
minorities gender
inequalities
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients
with complex
comorbidities increase
in certain diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing demand for
services Increasing
costsneed to make
limited resources go
further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
Decisions about value
marketization
Technological
development
Access to
information new
media technology
Facilitates self
determination increases
expectations and choice
population better
informed about
conditionsservicesright
s and less deferential
Users better able to
35
mobilise
Increased exclusion of
some groups with limited
access
New models of remote
care provision
Ability to exchange
information on quality
and experience
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Increasing costs
Decisions about value
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Organisational
change changing
management
styles
philosophies
Creating new
organisational
forms application
of more responsive
management
processes
performance
management
culture
Integration of
organisationsfunctions
new approaches to
lsquocommissioningrsquo of
organisationsservices
distortions caused by
lsquolocked inrsquo expenditures
(tertiary health care
residential care)
Decentralisation
deinstitutionalisation
marketization liberalisation
The lsquoenabling
statersquo Political
will fiscal space
Impact of financial
crisis competing
priorities for public
funds
Legacy of category-based
(not needs based) social
protection structural
transition
deindustrialisation
Health
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
EmpowermentSelf-
determination choice
Demand for more
individualised services of
better quality
Users better able to mobilise
Assertive lsquouserrsquo
knowledgeable patient
Alternativecomplimentary
providers
36
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demands on
services
Potential for poor access
to services (from
communication
problems social
isolation)
MulticulturalismTrained
health professionals
move to richer countries
integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Declining female
caregiving
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
Increased demand for
formal care services
Continued
inequalities
Unequal
distribution of
health risks and
health
outcomediseases
by socioeconomic
indicators
Unequal access to
care by social
status geography
gender and
ethnicity
Demographic Increase in
numbers of over
Increase in patients with
complex comorbidities
Increasing demand for care
Decisions about value Active
37
change 65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing costsneed to
make limited resources
go further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
ageing paradigm
Technological
development
Access to
information new
media technology
Self determination
expectations choice
population better
informed about
conditionsservicesright
s and less deferential
Ability to exchange
information on quality
and experience
New models of care provision
(eg telehealth care) new
health management systems
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Changing
management
stylesphilosophi
es
Application of
more responsive
management
processes
Decentralisation
deinstitutionalisation
marketization liberalisation
Lifestyle changes Increase in certain
diseases related to
obesity alcohol
and drug
Increasing
costsdemands for care
38
consumption and
stress diabetes
liver disease
anxiety and
depression
Education
Aspirations Rising expectations
by citizens for
better quality of
life
Self determination
choice consumerism
Education outside of formal
setting
Assertive user
Lifelong learningeducation
Migration Historical (post
colonial) migration
pan-EU migration
refugees
New needs for education
eg language and culture
Inequalities social
fragmentation
Social Roles Changing family
structure increase
in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
changing gender
roles rising
female
employment rates
Need to reconcile work
and family life
Parentingfamily skills
for vulnerable
parentsfamilies
Socialization of children
ndash social and emotional
deficits for children in
some environments
Work with families and
communities
Continued
inequalities
Inequality in
educational
accessattainment
by socioeconomic
status gender
people with
disabilities ethnic
minorities
Culture of failure
Promise to deliver social
mobility and economic
improvement
(Leadbeater and Wond
2010 pp 5-20)
Inclusive and multicultural
education
Differential support for
children from
lsquodisadvantagedrsquo
backgrounds
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients with
complex comorbidities
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
New group of older
39
learners
Technological
advance
Access to
information new
media technology
making learning
available in new
ways
Self determination
expectations choice
lsquoAssertive userrsquo
Increased exclusion of
some groups with limited
access
Changing
management
styles
philosophies
Community based models
Globalization Need to provide
educationtraining
which is suited to
modern knowledge
based global
economies
This report for the InnoServ project (grant agreement nr 290542) is supported
under the Socio-economic and Humanities Programme of FP7
Chris Hawker
Faculty of Health Sciences University of Southampton Building 67 University Road Highfield Campus Southampton SO17 1BJ
Tel +44 (0)23 8059 7968
Email CHawkersotonacuk
33
Appendix 3 analysis of social challenges and changes driving innovation
Welfare
Societal
change as
driving force
of innovation
in social
services
Meaning
description
Related
outcomesother
factors
Examples of innovative
responses
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
Empowerment self-
determination choice
The lsquoassertive userrsquo
Demand for more
individualised services of
better quality
Alternativecomplementary
providers
Personalisation
Co-production (new
userprofessional
relationships)
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demand on services
Potential for poor access
to services (from
communication
problems social
isolation)
Multiculturalism
Integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Declining female
caregiving
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
34
Increased demand for
services demand for
formal care
Continued
inequality
Continued
economic
inequality
unemployment
continued poverty
including child
poverty continued
institutionalisation
continued
inequality for
people with
disabilities ethnic
minorities gender
inequalities
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients
with complex
comorbidities increase
in certain diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing demand for
services Increasing
costsneed to make
limited resources go
further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
Decisions about value
marketization
Technological
development
Access to
information new
media technology
Facilitates self
determination increases
expectations and choice
population better
informed about
conditionsservicesright
s and less deferential
Users better able to
35
mobilise
Increased exclusion of
some groups with limited
access
New models of remote
care provision
Ability to exchange
information on quality
and experience
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Increasing costs
Decisions about value
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Organisational
change changing
management
styles
philosophies
Creating new
organisational
forms application
of more responsive
management
processes
performance
management
culture
Integration of
organisationsfunctions
new approaches to
lsquocommissioningrsquo of
organisationsservices
distortions caused by
lsquolocked inrsquo expenditures
(tertiary health care
residential care)
Decentralisation
deinstitutionalisation
marketization liberalisation
The lsquoenabling
statersquo Political
will fiscal space
Impact of financial
crisis competing
priorities for public
funds
Legacy of category-based
(not needs based) social
protection structural
transition
deindustrialisation
Health
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
EmpowermentSelf-
determination choice
Demand for more
individualised services of
better quality
Users better able to mobilise
Assertive lsquouserrsquo
knowledgeable patient
Alternativecomplimentary
providers
36
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demands on
services
Potential for poor access
to services (from
communication
problems social
isolation)
MulticulturalismTrained
health professionals
move to richer countries
integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Declining female
caregiving
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
Increased demand for
formal care services
Continued
inequalities
Unequal
distribution of
health risks and
health
outcomediseases
by socioeconomic
indicators
Unequal access to
care by social
status geography
gender and
ethnicity
Demographic Increase in
numbers of over
Increase in patients with
complex comorbidities
Increasing demand for care
Decisions about value Active
37
change 65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing costsneed to
make limited resources
go further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
ageing paradigm
Technological
development
Access to
information new
media technology
Self determination
expectations choice
population better
informed about
conditionsservicesright
s and less deferential
Ability to exchange
information on quality
and experience
New models of care provision
(eg telehealth care) new
health management systems
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Changing
management
stylesphilosophi
es
Application of
more responsive
management
processes
Decentralisation
deinstitutionalisation
marketization liberalisation
Lifestyle changes Increase in certain
diseases related to
obesity alcohol
and drug
Increasing
costsdemands for care
38
consumption and
stress diabetes
liver disease
anxiety and
depression
Education
Aspirations Rising expectations
by citizens for
better quality of
life
Self determination
choice consumerism
Education outside of formal
setting
Assertive user
Lifelong learningeducation
Migration Historical (post
colonial) migration
pan-EU migration
refugees
New needs for education
eg language and culture
Inequalities social
fragmentation
Social Roles Changing family
structure increase
in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
changing gender
roles rising
female
employment rates
Need to reconcile work
and family life
Parentingfamily skills
for vulnerable
parentsfamilies
Socialization of children
ndash social and emotional
deficits for children in
some environments
Work with families and
communities
Continued
inequalities
Inequality in
educational
accessattainment
by socioeconomic
status gender
people with
disabilities ethnic
minorities
Culture of failure
Promise to deliver social
mobility and economic
improvement
(Leadbeater and Wond
2010 pp 5-20)
Inclusive and multicultural
education
Differential support for
children from
lsquodisadvantagedrsquo
backgrounds
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients with
complex comorbidities
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
New group of older
39
learners
Technological
advance
Access to
information new
media technology
making learning
available in new
ways
Self determination
expectations choice
lsquoAssertive userrsquo
Increased exclusion of
some groups with limited
access
Changing
management
styles
philosophies
Community based models
Globalization Need to provide
educationtraining
which is suited to
modern knowledge
based global
economies
This report for the InnoServ project (grant agreement nr 290542) is supported
under the Socio-economic and Humanities Programme of FP7
Chris Hawker
Faculty of Health Sciences University of Southampton Building 67 University Road Highfield Campus Southampton SO17 1BJ
Tel +44 (0)23 8059 7968
Email CHawkersotonacuk
34
Increased demand for
services demand for
formal care
Continued
inequality
Continued
economic
inequality
unemployment
continued poverty
including child
poverty continued
institutionalisation
continued
inequality for
people with
disabilities ethnic
minorities gender
inequalities
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients
with complex
comorbidities increase
in certain diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing demand for
services Increasing
costsneed to make
limited resources go
further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
Decisions about value
marketization
Technological
development
Access to
information new
media technology
Facilitates self
determination increases
expectations and choice
population better
informed about
conditionsservicesright
s and less deferential
Users better able to
35
mobilise
Increased exclusion of
some groups with limited
access
New models of remote
care provision
Ability to exchange
information on quality
and experience
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Increasing costs
Decisions about value
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Organisational
change changing
management
styles
philosophies
Creating new
organisational
forms application
of more responsive
management
processes
performance
management
culture
Integration of
organisationsfunctions
new approaches to
lsquocommissioningrsquo of
organisationsservices
distortions caused by
lsquolocked inrsquo expenditures
(tertiary health care
residential care)
Decentralisation
deinstitutionalisation
marketization liberalisation
The lsquoenabling
statersquo Political
will fiscal space
Impact of financial
crisis competing
priorities for public
funds
Legacy of category-based
(not needs based) social
protection structural
transition
deindustrialisation
Health
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
EmpowermentSelf-
determination choice
Demand for more
individualised services of
better quality
Users better able to mobilise
Assertive lsquouserrsquo
knowledgeable patient
Alternativecomplimentary
providers
36
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demands on
services
Potential for poor access
to services (from
communication
problems social
isolation)
MulticulturalismTrained
health professionals
move to richer countries
integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Declining female
caregiving
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
Increased demand for
formal care services
Continued
inequalities
Unequal
distribution of
health risks and
health
outcomediseases
by socioeconomic
indicators
Unequal access to
care by social
status geography
gender and
ethnicity
Demographic Increase in
numbers of over
Increase in patients with
complex comorbidities
Increasing demand for care
Decisions about value Active
37
change 65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing costsneed to
make limited resources
go further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
ageing paradigm
Technological
development
Access to
information new
media technology
Self determination
expectations choice
population better
informed about
conditionsservicesright
s and less deferential
Ability to exchange
information on quality
and experience
New models of care provision
(eg telehealth care) new
health management systems
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Changing
management
stylesphilosophi
es
Application of
more responsive
management
processes
Decentralisation
deinstitutionalisation
marketization liberalisation
Lifestyle changes Increase in certain
diseases related to
obesity alcohol
and drug
Increasing
costsdemands for care
38
consumption and
stress diabetes
liver disease
anxiety and
depression
Education
Aspirations Rising expectations
by citizens for
better quality of
life
Self determination
choice consumerism
Education outside of formal
setting
Assertive user
Lifelong learningeducation
Migration Historical (post
colonial) migration
pan-EU migration
refugees
New needs for education
eg language and culture
Inequalities social
fragmentation
Social Roles Changing family
structure increase
in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
changing gender
roles rising
female
employment rates
Need to reconcile work
and family life
Parentingfamily skills
for vulnerable
parentsfamilies
Socialization of children
ndash social and emotional
deficits for children in
some environments
Work with families and
communities
Continued
inequalities
Inequality in
educational
accessattainment
by socioeconomic
status gender
people with
disabilities ethnic
minorities
Culture of failure
Promise to deliver social
mobility and economic
improvement
(Leadbeater and Wond
2010 pp 5-20)
Inclusive and multicultural
education
Differential support for
children from
lsquodisadvantagedrsquo
backgrounds
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients with
complex comorbidities
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
New group of older
39
learners
Technological
advance
Access to
information new
media technology
making learning
available in new
ways
Self determination
expectations choice
lsquoAssertive userrsquo
Increased exclusion of
some groups with limited
access
Changing
management
styles
philosophies
Community based models
Globalization Need to provide
educationtraining
which is suited to
modern knowledge
based global
economies
This report for the InnoServ project (grant agreement nr 290542) is supported
under the Socio-economic and Humanities Programme of FP7
Chris Hawker
Faculty of Health Sciences University of Southampton Building 67 University Road Highfield Campus Southampton SO17 1BJ
Tel +44 (0)23 8059 7968
Email CHawkersotonacuk
35
mobilise
Increased exclusion of
some groups with limited
access
New models of remote
care provision
Ability to exchange
information on quality
and experience
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Increasing costs
Decisions about value
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Organisational
change changing
management
styles
philosophies
Creating new
organisational
forms application
of more responsive
management
processes
performance
management
culture
Integration of
organisationsfunctions
new approaches to
lsquocommissioningrsquo of
organisationsservices
distortions caused by
lsquolocked inrsquo expenditures
(tertiary health care
residential care)
Decentralisation
deinstitutionalisation
marketization liberalisation
The lsquoenabling
statersquo Political
will fiscal space
Impact of financial
crisis competing
priorities for public
funds
Legacy of category-based
(not needs based) social
protection structural
transition
deindustrialisation
Health
Aspirations Rising expectations
of citizens for
better quality of
lifebetter care
EmpowermentSelf-
determination choice
Demand for more
individualised services of
better quality
Users better able to mobilise
Assertive lsquouserrsquo
knowledgeable patient
Alternativecomplimentary
providers
36
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demands on
services
Potential for poor access
to services (from
communication
problems social
isolation)
MulticulturalismTrained
health professionals
move to richer countries
integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Declining female
caregiving
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
Increased demand for
formal care services
Continued
inequalities
Unequal
distribution of
health risks and
health
outcomediseases
by socioeconomic
indicators
Unequal access to
care by social
status geography
gender and
ethnicity
Demographic Increase in
numbers of over
Increase in patients with
complex comorbidities
Increasing demand for care
Decisions about value Active
37
change 65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing costsneed to
make limited resources
go further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
ageing paradigm
Technological
development
Access to
information new
media technology
Self determination
expectations choice
population better
informed about
conditionsservicesright
s and less deferential
Ability to exchange
information on quality
and experience
New models of care provision
(eg telehealth care) new
health management systems
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Changing
management
stylesphilosophi
es
Application of
more responsive
management
processes
Decentralisation
deinstitutionalisation
marketization liberalisation
Lifestyle changes Increase in certain
diseases related to
obesity alcohol
and drug
Increasing
costsdemands for care
38
consumption and
stress diabetes
liver disease
anxiety and
depression
Education
Aspirations Rising expectations
by citizens for
better quality of
life
Self determination
choice consumerism
Education outside of formal
setting
Assertive user
Lifelong learningeducation
Migration Historical (post
colonial) migration
pan-EU migration
refugees
New needs for education
eg language and culture
Inequalities social
fragmentation
Social Roles Changing family
structure increase
in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
changing gender
roles rising
female
employment rates
Need to reconcile work
and family life
Parentingfamily skills
for vulnerable
parentsfamilies
Socialization of children
ndash social and emotional
deficits for children in
some environments
Work with families and
communities
Continued
inequalities
Inequality in
educational
accessattainment
by socioeconomic
status gender
people with
disabilities ethnic
minorities
Culture of failure
Promise to deliver social
mobility and economic
improvement
(Leadbeater and Wond
2010 pp 5-20)
Inclusive and multicultural
education
Differential support for
children from
lsquodisadvantagedrsquo
backgrounds
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients with
complex comorbidities
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
New group of older
39
learners
Technological
advance
Access to
information new
media technology
making learning
available in new
ways
Self determination
expectations choice
lsquoAssertive userrsquo
Increased exclusion of
some groups with limited
access
Changing
management
styles
philosophies
Community based models
Globalization Need to provide
educationtraining
which is suited to
modern knowledge
based global
economies
This report for the InnoServ project (grant agreement nr 290542) is supported
under the Socio-economic and Humanities Programme of FP7
Chris Hawker
Faculty of Health Sciences University of Southampton Building 67 University Road Highfield Campus Southampton SO17 1BJ
Tel +44 (0)23 8059 7968
Email CHawkersotonacuk
36
Migration In-migration
Historical (post
colonial) migration
pan-EU migration
refugees
Issue of out-
migration for some
countries
Inequalities social
fragmentation
Potential for intolerance
and stereotyping
New demands on
services
Potential for poor access
to services (from
communication
problems social
isolation)
MulticulturalismTrained
health professionals
move to richer countries
integration projects
Social Roles Changing families
increase in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
Changing gender
roles rising
female
employment rates
Declining female
caregiving
Decreasing availability of
family support
structures
Decline in
intergenerational co-
residence increase in
older people living alone
Need to reconcile work
and family life
Changes within
parenthood particularly
fatherhood
Increased demand for
formal care services
Continued
inequalities
Unequal
distribution of
health risks and
health
outcomediseases
by socioeconomic
indicators
Unequal access to
care by social
status geography
gender and
ethnicity
Demographic Increase in
numbers of over
Increase in patients with
complex comorbidities
Increasing demand for care
Decisions about value Active
37
change 65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing costsneed to
make limited resources
go further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
ageing paradigm
Technological
development
Access to
information new
media technology
Self determination
expectations choice
population better
informed about
conditionsservicesright
s and less deferential
Ability to exchange
information on quality
and experience
New models of care provision
(eg telehealth care) new
health management systems
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Changing
management
stylesphilosophi
es
Application of
more responsive
management
processes
Decentralisation
deinstitutionalisation
marketization liberalisation
Lifestyle changes Increase in certain
diseases related to
obesity alcohol
and drug
Increasing
costsdemands for care
38
consumption and
stress diabetes
liver disease
anxiety and
depression
Education
Aspirations Rising expectations
by citizens for
better quality of
life
Self determination
choice consumerism
Education outside of formal
setting
Assertive user
Lifelong learningeducation
Migration Historical (post
colonial) migration
pan-EU migration
refugees
New needs for education
eg language and culture
Inequalities social
fragmentation
Social Roles Changing family
structure increase
in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
changing gender
roles rising
female
employment rates
Need to reconcile work
and family life
Parentingfamily skills
for vulnerable
parentsfamilies
Socialization of children
ndash social and emotional
deficits for children in
some environments
Work with families and
communities
Continued
inequalities
Inequality in
educational
accessattainment
by socioeconomic
status gender
people with
disabilities ethnic
minorities
Culture of failure
Promise to deliver social
mobility and economic
improvement
(Leadbeater and Wond
2010 pp 5-20)
Inclusive and multicultural
education
Differential support for
children from
lsquodisadvantagedrsquo
backgrounds
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients with
complex comorbidities
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
New group of older
39
learners
Technological
advance
Access to
information new
media technology
making learning
available in new
ways
Self determination
expectations choice
lsquoAssertive userrsquo
Increased exclusion of
some groups with limited
access
Changing
management
styles
philosophies
Community based models
Globalization Need to provide
educationtraining
which is suited to
modern knowledge
based global
economies
This report for the InnoServ project (grant agreement nr 290542) is supported
under the Socio-economic and Humanities Programme of FP7
Chris Hawker
Faculty of Health Sciences University of Southampton Building 67 University Road Highfield Campus Southampton SO17 1BJ
Tel +44 (0)23 8059 7968
Email CHawkersotonacuk
37
change 65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
Increasing costsneed to
make limited resources
go further
Need to address
pensions care support
housing mobility
isolation
Implications on
recruitment to health
and social care jobs
ageing paradigm
Technological
development
Access to
information new
media technology
Self determination
expectations choice
population better
informed about
conditionsservicesright
s and less deferential
Ability to exchange
information on quality
and experience
New models of care provision
(eg telehealth care) new
health management systems
Medical advance Medical
developments
which offer
opportunities to
improve clinical
outcomes
Changing nature of
disease - Acute diseases
(eg cancer and heart
disease) becoming
chronic
Increase in longer term
care needs
Technological advance
can increase cost
pressures
Changing
management
stylesphilosophi
es
Application of
more responsive
management
processes
Decentralisation
deinstitutionalisation
marketization liberalisation
Lifestyle changes Increase in certain
diseases related to
obesity alcohol
and drug
Increasing
costsdemands for care
38
consumption and
stress diabetes
liver disease
anxiety and
depression
Education
Aspirations Rising expectations
by citizens for
better quality of
life
Self determination
choice consumerism
Education outside of formal
setting
Assertive user
Lifelong learningeducation
Migration Historical (post
colonial) migration
pan-EU migration
refugees
New needs for education
eg language and culture
Inequalities social
fragmentation
Social Roles Changing family
structure increase
in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
changing gender
roles rising
female
employment rates
Need to reconcile work
and family life
Parentingfamily skills
for vulnerable
parentsfamilies
Socialization of children
ndash social and emotional
deficits for children in
some environments
Work with families and
communities
Continued
inequalities
Inequality in
educational
accessattainment
by socioeconomic
status gender
people with
disabilities ethnic
minorities
Culture of failure
Promise to deliver social
mobility and economic
improvement
(Leadbeater and Wond
2010 pp 5-20)
Inclusive and multicultural
education
Differential support for
children from
lsquodisadvantagedrsquo
backgrounds
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients with
complex comorbidities
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
New group of older
39
learners
Technological
advance
Access to
information new
media technology
making learning
available in new
ways
Self determination
expectations choice
lsquoAssertive userrsquo
Increased exclusion of
some groups with limited
access
Changing
management
styles
philosophies
Community based models
Globalization Need to provide
educationtraining
which is suited to
modern knowledge
based global
economies
This report for the InnoServ project (grant agreement nr 290542) is supported
under the Socio-economic and Humanities Programme of FP7
Chris Hawker
Faculty of Health Sciences University of Southampton Building 67 University Road Highfield Campus Southampton SO17 1BJ
Tel +44 (0)23 8059 7968
Email CHawkersotonacuk
38
consumption and
stress diabetes
liver disease
anxiety and
depression
Education
Aspirations Rising expectations
by citizens for
better quality of
life
Self determination
choice consumerism
Education outside of formal
setting
Assertive user
Lifelong learningeducation
Migration Historical (post
colonial) migration
pan-EU migration
refugees
New needs for education
eg language and culture
Inequalities social
fragmentation
Social Roles Changing family
structure increase
in single
households
increase in single
parent families
changing
generational
relations (due to
longer life
expectancy)
reduction in
extended families
changing gender
roles rising
female
employment rates
Need to reconcile work
and family life
Parentingfamily skills
for vulnerable
parentsfamilies
Socialization of children
ndash social and emotional
deficits for children in
some environments
Work with families and
communities
Continued
inequalities
Inequality in
educational
accessattainment
by socioeconomic
status gender
people with
disabilities ethnic
minorities
Culture of failure
Promise to deliver social
mobility and economic
improvement
(Leadbeater and Wond
2010 pp 5-20)
Inclusive and multicultural
education
Differential support for
children from
lsquodisadvantagedrsquo
backgrounds
Demographic
change
Increase in
numbers of over
65s Greatest
increase in over 80
age group
Increase in old age
dependency ratio
Increase in patients with
complex comorbidities
increase in certain
diseases eg
Alzheimerrsquos Increasing
heterogeneity of older
age groups eg ethnic
minority older people
older people in areas of
social deprivation
New group of older
39
learners
Technological
advance
Access to
information new
media technology
making learning
available in new
ways
Self determination
expectations choice
lsquoAssertive userrsquo
Increased exclusion of
some groups with limited
access
Changing
management
styles
philosophies
Community based models
Globalization Need to provide
educationtraining
which is suited to
modern knowledge
based global
economies
This report for the InnoServ project (grant agreement nr 290542) is supported
under the Socio-economic and Humanities Programme of FP7
Chris Hawker
Faculty of Health Sciences University of Southampton Building 67 University Road Highfield Campus Southampton SO17 1BJ
Tel +44 (0)23 8059 7968
Email CHawkersotonacuk
39
learners
Technological
advance
Access to
information new
media technology
making learning
available in new
ways
Self determination
expectations choice
lsquoAssertive userrsquo
Increased exclusion of
some groups with limited
access
Changing
management
styles
philosophies
Community based models
Globalization Need to provide
educationtraining
which is suited to
modern knowledge
based global
economies
This report for the InnoServ project (grant agreement nr 290542) is supported
under the Socio-economic and Humanities Programme of FP7
Chris Hawker
Faculty of Health Sciences University of Southampton Building 67 University Road Highfield Campus Southampton SO17 1BJ
Tel +44 (0)23 8059 7968
Email CHawkersotonacuk